Healthcare Provider Details

I. General information

NPI: 1497754428
Provider Name (Legal Business Name): PIERRE E DIONNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST
OLEAN NY
14760-1513
US

IV. Provider business mailing address

535 MAIN ST
OLEAN NY
14760-1513
US

V. Phone/Fax

Practice location:
  • Phone: 716-376-2203
  • Fax: 716-373-6632
Mailing address:
  • Phone: 716-376-2203
  • Fax: 716-373-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number174130
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number174130
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01087989
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: