Healthcare Provider Details

I. General information

NPI: 1942267455
Provider Name (Legal Business Name): SOUTHWESTERN MEDICAL ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

V. Phone/Fax

Practice location:
  • Phone: 716-972-0279
  • Fax: 716-972-0273
Mailing address:
  • Phone: 716-972-0279
  • Fax: 716-972-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GAIL GOODMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 716-972-0279