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General NPI Number Information
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NPI Number | 1689986317
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Entity Type | Organization
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Legal Business Name | DAVID S BEVILACQUA MD PC
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | S-3673 SOUTHWESTERN BLVD
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1740
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Country | US
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Telephone | 716-662-8087
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Fax |
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Provider Business Mailing Address
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Address Line | S-3673 SOUTHWESTERN BLVD
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1740
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Country | US
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Telephone | 716-662-8089
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID SAMUEL BEVILACQUA
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Credential | MD
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Telephone | 716-662-8089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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