Healthcare Provider Details

I. General information

NPI: 1972736825
Provider Name (Legal Business Name): DEREK M AUBE-MARCHANT RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. DEREK M MARCHANT

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E ROBINSON RD SUITE 207
BUFFALO NY
14228-2041
US

IV. Provider business mailing address

1150 YOUNGS RD SUITE 104
WILLIAMSVILLE NY
14221-8053
US

V. Phone/Fax

Practice location:
  • Phone: 716-564-1111
  • Fax: 716-564-1128
Mailing address:
  • Phone: 716-636-7990
  • Fax: 716-636-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013319-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: