Healthcare Provider Details

I. General information

NPI: 1457315707
Provider Name (Legal Business Name): FIONA C HALLIDAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5879 SNYDER DR
LOCKPORT NY
14094-9497
US

IV. Provider business mailing address

5879 SNYDER DR
LOCKPORT NY
14094-9497
US

V. Phone/Fax

Practice location:
  • Phone: 716-433-8751
  • Fax: 716-433-8792
Mailing address:
  • Phone: 716-433-8751
  • Fax: 716-433-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number212450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: