Healthcare Provider Details

I. General information

NPI: 1710944632
Provider Name (Legal Business Name): DAVID AVINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 SOUTHWESTERN BLVD SUITE 107
ORCHARD PARK NY
14127-1752
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD SUITE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-2062
  • Fax: 716-667-2063
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number199233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: