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General NPI Number Information
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NPI Number | 1710164066
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Entity Type | Organization
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Legal Business Name | LOUBERT S SUDDABY MD PC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 3775 SOUTHWESTERN BLVD SUITE A
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2159
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Country | US
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Telephone | 716-667-1980
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Fax | 716-667-1982
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Provider Business Mailing Address
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Address Line | 3775 SOUTHWESTERN BLVD SUITE A
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2159
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Country | US
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Telephone | 716-667-1980
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Fax | 716-667-1982
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUSAN L WHIPPLE
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Credential |
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Telephone | 716-667-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 193722
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License Number State | NY
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