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NPI Code Detail

MEDICARE: MR. RUSSELL CLARENCE TALMA PA-C

MEDICARE: MR. RUSSELL CLARENCE TALMA PA-C
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
1363A00000XPhysician Assistant007105NY

General Provider Information

NPI Number : 1679558860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RUSSELL CLARENCE TALMA PA-C
Provider Business Mailing Address
First Line : 6698 MACINTOSH LN
Second Line :
City : N TONAWANDA
State : NY
Zip : 14120-9648
Country : US
Telephone Number : 716-210-3043
Fax Number : 716-862-8600
Provider Business Practice Location Address
First Line : 3495 BAILEY AVE
Second Line : VA MEDICAL CENTER. DEPT OF SURGERY
City : BUFFALO
State : NY
Zip : 14215-1129
Country : US
Telephone Number : 716-862-8500
Fax Number : 716-862-8600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 05/06/2013

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