Healthcare Provider Details

I. General information

NPI: 1891767455
Provider Name (Legal Business Name): TODD ALLEN ROLAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-1901
  • Fax: 716-689-2238
Mailing address:
  • Phone: 716-689-1901
  • Fax: 716-689-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005834-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: