Healthcare Provider Details

I. General information

NPI: 1669578183
Provider Name (Legal Business Name): FRONTIER CARDIOTHORACIC SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GATES CIR
BUFFALO NY
14209-1120
US

IV. Provider business mailing address

3 GATES CIR
BUFFALO NY
14209-1120
US

V. Phone/Fax

Practice location:
  • Phone: 716-887-4102
  • Fax: 716-887-4103
Mailing address:
  • Phone: 716-887-4102
  • Fax: 716-887-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number205639
License Number StateNY

VIII. Authorized Official

Name: DR. SUBHAJIT DATTA
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 716-887-4102