Provider Demographics
NPI:1043319437
Name:BUSCEMI, MELCHIORE LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MELCHIORE
Middle Name:LOUIS
Last Name:BUSCEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1450
Mailing Address - Country:US
Mailing Address - Phone:315-854-8055
Mailing Address - Fax:315-379-9900
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1450
Practice Address - Country:US
Practice Address - Phone:315-854-8055
Practice Address - Fax:315-379-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160275208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE73182Medicare UPIN
NYBB3107Medicare PIN