MEDICARE: JAMES M WOPPERER 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	174400000X	Specialist	155653	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0454390001	OTHER	NY	MEDICARE-DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0903962	OTHER	NY	INDEPENDENT HEALTH
3	000510318001	OTHER	NY	BLUE CROSS OF WNY
4	0022755	OTHER	NY	GROUP HEALTH INSURANCE
5	00010290601	OTHER	NY	UNIVERA HEALTHCARE

General Provider Information

NPI Number	:	1861498990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M WOPPERER M.D.

Provider Business Mailing Address
First Line	:	5320 MILITARY RD
Second Line	:	SUITE 107
City	:	LEWISTON
State	:	NY
Zip	:	14092-2149
Country	:	US
Telephone Number	:	716-297-1701
Fax Number	:	716-297-1479

Provider Business Practice Location Address
First Line	:	5320 MILITARY RD
Second Line	:	SUITE 107
City	:	LEWISTON
State	:	NY
Zip	:	14092-2149
Country	:	US
Telephone Number	:	716-297-1701
Fax Number	:	716-297-1479

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	12/28/2009

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Directions to “ JAMES M WOPPERER M.D.” Practice Location

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