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General NPI Number Information
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NPI Number | 1013338052
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Entity Type | Individual
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Provider Name | SRIDHAR NILAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 1408 SWEET HOME RD SUITE 9
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City | AMHERST
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State | NY
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Zip | 14228-2783
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Country | US
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Telephone | 716-247-5281
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Fax |
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Provider Business Mailing Address
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Address Line | 115 SPRING MEADOW DR APT #8
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8425
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 270638
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License Number State | NY
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