Healthcare Provider Details

I. General information

NPI: 1629004072
Provider Name (Legal Business Name): BURNS MD AND HAGE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 ERIE RD
DERBY NY
14047-9306
US

IV. Provider business mailing address

7020 ERIE RD
DERBY NY
14047-9306
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-4545
  • Fax: 716-947-6146
Mailing address:
  • Phone: 716-947-4545
  • Fax: 716-947-6146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS D HAGE
Title or Position: PARTNER
Credential: MD
Phone: 716-947-4545