Provider Demographics
NPI:1063502235
Name:TALAL, ANDREW HENRY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HENRY
Last Name:TALAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:875 ELLICOTT ST
Mailing Address - Street 2:SUITE 6090
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1070
Mailing Address - Country:US
Mailing Address - Phone:716-888-4738
Mailing Address - Fax:716-854-1397
Practice Address - Street 1:875 ELLICOTT ST
Practice Address - Street 2:SUITE 6090
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1070
Practice Address - Country:US
Practice Address - Phone:716-888-4738
Practice Address - Fax:716-854-1397
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY203220207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134783Medicaid
NYJ400077596Medicare PIN