MEDICARE: MR. JOSEPH R. ODDO PA

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	363A00000X	Physician Assistant	006442-1	NY

General Provider Information

NPI Number	:	1386681609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH R. ODDO PA

Provider Business Mailing Address
First Line	:	51 OVERBROOK AVE
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-8301
Country	:	US
Telephone Number	:	716-836-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2949 ELMWOOD AVE
Second Line	:	203
City	:	KENMORE
State	:	NY
Zip	:	14217-1356
Country	:	US
Telephone Number	:	716-447-8868
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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