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NPI Code Detail

MEDICARE: DR. LOUBERT STEVEN SUDDABY MD

MEDICARE:  DR. LOUBERT STEVEN SUDDABY  MD
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
1207T00000XNeurological Surgery Physician193722NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5140003497OTHERNYRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10002052461OTHERNYUNIVERA
2000523004003OTHERNYBCBS
3111253CGOTHERNYPREFERRED CARE
40607039OTHERNYINDEPENDENT HEALTH
66001373OTHERNYGROUP HEALTH INC

General Provider Information

NPI Number : 1609869783
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOUBERT STEVEN SUDDABY MD
Provider Business Mailing Address
First Line : 4855 CAMP RD STE 400
Second Line :
City : HAMBURG
State : NY
Zip : 14075-2600
Country : US
Telephone Number : 716-648-6875
Fax Number : 716-648-6939
Provider Business Practice Location Address
First Line : 4855 CAMP RD STE 400
Second Line :
City : HAMBURG
State : NY
Zip : 14075-2600
Country : US
Telephone Number : 716-648-6875
Fax Number : 716-648-6939
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 06/26/2019

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Directions to “ DR. LOUBERT STEVEN SUDDABY MD” Practice Location

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