Healthcare Provider Details

I. General information

NPI: 1699096289
Provider Name (Legal Business Name): SALVADOR M UDAGAWA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 MAIN ST
BUFFALO NY
14214-1316
US

IV. Provider business mailing address

3404 MAIN ST
BUFFALO NY
14214-1316
US

V. Phone/Fax

Practice location:
  • Phone: 716-835-0641
  • Fax: 716-835-3450
Mailing address:
  • Phone: 716-835-0641
  • Fax: 716-835-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number117941
License Number StateNY

VIII. Authorized Official

Name: MR. SALVADOR M UDAGAWA
Title or Position: PRESIDENT
Credential: MD
Phone: 716-835-0641