Healthcare Provider Details

I. General information

NPI: 1740422708
Provider Name (Legal Business Name): DAVID CIPOLLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N MAPLEMERE RD STE 120
WILLIAMSVILLE NY
14221-3178
US

IV. Provider business mailing address

111 N MAPLEMERE RD STE 120
WILLIAMSVILLE NY
14221-3178
US

V. Phone/Fax

Practice location:
  • Phone: 716-836-4646
  • Fax: 716-836-4696
Mailing address:
  • Phone: 716-836-4646
  • Fax: 716-836-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number237994-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: