1861498990 NPI number — JAMES M WOPPERER M.D.

Table of content: JAMES M WOPPERER M.D. (NPI 1861498990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861498990 NPI number — JAMES M WOPPERER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOPPERER
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861498990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5320 MILITARY RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14092-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-297-1701
Provider Business Practice Location Address Fax Number:
716-297-1479
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  155653 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0454390001 . This is a "MEDICARE-DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0903962 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000510318001 . This is a "BLUE CROSS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0022755 . This is a "GROUP HEALTH INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010290601 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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