Healthcare Provider Details

I. General information

NPI: 1477589471
Provider Name (Legal Business Name): TAHIR M QAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MEAD ST
NORTH TONAWANDA NY
14120-4435
US

IV. Provider business mailing address

338 HARRIS HILL RD SUITE 207
WILLIAMSVILLE NY
14221-7470
US

V. Phone/Fax

Practice location:
  • Phone: 716-692-4020
  • Fax: 716-692-5090
Mailing address:
  • Phone: 716-634-4798
  • Fax: 716-634-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number236351-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number236351-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: