MEDICARE: DR. SUSAN BALDASSARI 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	207R00000X	Internal Medicine Physician	167163	NY

General Provider Information

NPI Number	:	1245270388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN BALDASSARI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 488
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14240-0488
Country	:	US
Telephone Number	:	716-852-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 TREMONT ST STE 3
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-220-8002
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	04/17/2024

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