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General NPI Number Information
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NPI Number | 1154071934
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Entity Type | Organization
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Legal Business Name | EDEN PRIMARY CARE
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 8274 N MAIN ST
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City | EDEN
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State | NY
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Zip | 14057-1104
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Country | US
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Telephone | 716-725-8114
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Fax |
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Provider Business Mailing Address
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Address Line | 8274 N MAIN ST
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City | EDEN
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State | NY
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Zip | 14057-1104
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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 | OWNER
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Name | BRIGID O'GORMAN
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Credential | MD
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Telephone | 716-575-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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