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NPI Code Detail

MEDICARE: BRUMMITTE DALE WILSON M.D.

MEDICARE: BRUMMITTE DALE WILSON 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
1207ND0101XMOHS-Micrographic Surgery Physician134469NY
2207NS0135XProcedural Dermatology Physician1344691NY

General Provider Information

NPI Number : 1245237288
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUMMITTE DALE WILSON M.D.
Provider Business Mailing Address
First Line : 425 ESSJAY RD STE 170
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8235
Country : US
Telephone Number : 716-630-1219
Fax Number : 716-817-1726
Provider Business Practice Location Address
First Line : 3900 N BUFFALO ST
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-1842
Country : US
Telephone Number : 716-656-4494
Fax Number : 716-648-1552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2005
Last Update Date : 09/24/2024

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