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General NPI Number Information
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NPI Number | 1942298104
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Entity Type | Individual
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Provider Name | DAVID L BAGNALL MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 3925 SHERIDAN DR
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City | AMHERST
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State | NY
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Zip | 14226-1718
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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 | 5500 MAIN ST 107
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6766
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Country | US
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Telephone | 716-906-5908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 199397-1
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License Number State | NY
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