Healthcare Provider Details

I. General information

NPI: 1427073923
Provider Name (Legal Business Name): GARY NADEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OHIO ST
MEDINA NY
14103-1063
US

IV. Provider business mailing address

171 BAUMAN RD
WILLIAMSVILLE NY
14221-3803
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2000
  • Fax:
Mailing address:
  • Phone: 716-634-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35078394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: