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General NPI Number Information
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NPI Number | 1285779751
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Entity Type | Organization
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Legal Business Name | CRAIG M. FETTERMAN, D.O.,P.C.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 2950 ELMWOOD AVE
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City | KENMORE
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State | NY
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Zip | 14217-1304
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Country | US
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Telephone | 716-634-8800
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Fax | 716-634-8987
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Provider Business Mailing Address
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Address Line | 200 INTERNATIONAL DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8217
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Country | US
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Telephone | 716-634-8800
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Fax | 716-634-8987
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG M FETTERMAN
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Credential | D.O.
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Telephone | 716-634-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 230757-1
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License Number State | NY
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