Healthcare Provider Details

I. General information

NPI: 1942495635
Provider Name (Legal Business Name): DEIDRA WOMEN'S MEDICAL HEALTH SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 CENTRAL AVE SUITE 1
DUNKIRK NY
14048-2538
US

IV. Provider business mailing address

609 CENTRAL AVE SUITE 1
DUNKIRK NY
14048-2538
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-5222
  • Fax: 716-366-5224
Mailing address:
  • Phone: 716-366-5222
  • Fax: 716-366-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number210392-1
License Number StateNY

VIII. Authorized Official

Name: DR. COLLINS O. OSULA
Title or Position: M.D.
Credential: M.D.,F.A.C.O.G.
Phone: 716-366-5222