=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124069844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURORA HOSPITALIST, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 ABBOTT RD @MERCY HOSPITAL OF BUFFALO
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14220-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-383-5450
-----------------------------------------------------
Fax | 518-383-4223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 CLIFTON CORPORATE PKWY SUITE 428
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-383-5450
-----------------------------------------------------
Fax | 518-383-4223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, OWNER
-----------------------------------------------------
Name | JOHN A BRACH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 518-383-5450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------