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NPI Code Detail

MEDICARE: BRADFORD PERHAM MERSEREAU

MEDICARE: BRADFORD PERHAM MERSEREAU
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
1207Q00000XFamily Medicine Physician172072NY

General Provider Information

NPI Number : 1447231741
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADFORD PERHAM MERSEREAU
Provider Business Mailing Address
First Line : 3495 BAILEY AVE
Second Line : PRIMARY CARE GROUP 2
City : BUFFALO
State : NY
Zip : 14215-1129
Country : US
Telephone Number : 716-862-3641
Fax Number :
Provider Business Practice Location Address
First Line : 3495 BAILEY AVE
Second Line : PRIMARY CARE GROUP 2
City : BUFFALO
State : NY
Zip : 14215-1129
Country : US
Telephone Number : 716-862-3641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 12/16/2014

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Directions to “ BRADFORD PERHAM MERSEREAU ” Practice Location

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