Healthcare Provider Details

I. General information

NPI: 1457332827
Provider Name (Legal Business Name): CHARLES DANIEL RICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MILITARY RD
LEWISTON NY
14092-2149
US

IV. Provider business mailing address

5300 MILITARY RD
LEWISTON NY
14092-2149
US

V. Phone/Fax

Practice location:
  • Phone: 716-298-3012
  • Fax: 716-298-3016
Mailing address:
  • Phone: 716-298-3012
  • Fax: 716-298-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number136299 0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: