Provider Demographics
NPI:1225187271
Name:MADOW, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MADOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BOJIDAR
Other - Middle Name:
Other - Last Name:MADJAROV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1176 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2102
Mailing Address - Country:US
Mailing Address - Phone:716-881-7900
Mailing Address - Fax:716-881-4349
Practice Address - Street 1:1176 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2102
Practice Address - Country:US
Practice Address - Phone:716-881-7900
Practice Address - Fax:716-881-4349
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101419207W00000X
NY247586207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06463721Medicaid
FL53733OtherBLUE CROSS BLUE SHIELD
FL000388000Medicaid