Provider Demographics
NPI:1164447157
Name:TANDOC, MERLE N (MD)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:N
Last Name:TANDOC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 HARLEM RD RM 3
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-886-0444
Mailing Address - Fax:716-885-7070
Practice Address - Street 1:3095 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2500
Practice Address - Country:US
Practice Address - Phone:716-896-3815
Practice Address - Fax:716-896-3015
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139368207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00627376Medicaid
NY00627376Medicaid
NYR22125Medicare PIN