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General NPI Number Information
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NPI Number | 1518140490
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Entity Type | Organization
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Legal Business Name | DAVID L. BAGNALL MD PC
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 3980 SHERIDAN DR BUILDING A SUITE 102
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City | AMHERST
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State | NY
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Zip | 14226-1727
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Country | US
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Telephone | 716-250-6545
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Fax | 716-250-6566
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Provider Business Mailing Address
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Address Line | 3980 SHERIDAN DR BUILDING A SUITE 102
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City | AMHERST
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State | NY
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Zip | 14226-1727
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Country | US
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Telephone | 716-250-6545
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Fax | 716-250-6566
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID L BAGNALL
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Credential | MD
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Telephone | 716-250-6454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1993971
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License Number State | NY
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