Provider Demographics
NPI:1083689384
Name:HEARD, CHRISTOPHER MICHAEL BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL BRYAN
Last Name:HEARD
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 1:1001 MAIN ST # K3502
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-6570
Mailing Address - Fax:716-323-6658
Practice Address - Street 1:1001 MAIN ST # K3502
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-6570
Practice Address - Fax:716-323-6658
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2021322080P0203X
NY2021321207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010201901OtherUNIVERA
040426001276OtherFIDELIS
2008190OtherIHA
000524184003OtherBC/BS
PA0016874670001Medicaid
NY01647754Medicaid
040426001276OtherFIDELIS
PA0016874670001Medicaid
11914QMedicare PIN