MEDICARE: DARYL ROY EHLENFIELD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	209031	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	144080DL	OTHER	NY	PREFERRED CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000525174009	OTHER	NY	COMMUNITY BLUE
4	1201351	OTHER	NY	IHA
5	00010364108	OTHER	NY	UNIVERA
6	040426001840	OTHER	NY	FIDELIS

General Provider Information

NPI Number	:	1033117809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL ROY EHLENFIELD M.D.

Provider Business Mailing Address
First Line	:	560 FRANKLIN ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1110
Country	:	US
Telephone Number	:	716-332-4472
Fax Number	:	716-332-4474

Provider Business Practice Location Address
First Line	:	560 FRANKLIN ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1110
Country	:	US
Telephone Number	:	716-332-4472
Fax Number	:	716-332-4474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/26/2014

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