Provider Demographics
NPI:1073613196
Name:CARFAGNA, VINCENT OLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:OLIN
Last Name:CARFAGNA
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 1:6300 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3216
Mailing Address - Country:US
Mailing Address - Phone:716-667-3200
Mailing Address - Fax:716-667-3120
Practice Address - Street 1:6300 POWERS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3216
Practice Address - Country:US
Practice Address - Phone:716-667-3200
Practice Address - Fax:716-667-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603750Medicaid
NY00010201801OtherUNIVERA HEALTHCARE
NY000502255001OtherBLUE CROSS AND BLUE SHIEL
NY0101548OtherINDEPENDENT HEALTH
NY161098763OtherTIN
NY00010201801OtherUNIVERA HEALTHCARE
NY022551Medicare ID - Type Unspecified