Healthcare Provider Details

I. General information

NPI: 1831593268
Provider Name (Legal Business Name): LANCASTER PRIMARY CARE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 TRANSIT RD
DEPEW NY
14043-4617
US

IV. Provider business mailing address

PO BOX 248
ELLICOTTVILLE NY
14731-0248
US

V. Phone/Fax

Practice location:
  • Phone: 716-650-5516
  • Fax: 716-650-5515
Mailing address:
  • Phone: 716-699-9032
  • Fax: 716-699-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN C RADFORD
Title or Position: OWNER
Credential: MD
Phone: 716-699-9032