Provider Demographics
NPI:1225271364
Name:BUFFALO ADVANCED MEDICAL, P.C.
Entity Type:Organization
Organization Name:BUFFALO ADVANCED MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:TRUDEAU
Authorized Official - Last Name:PLATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-984-7840
Mailing Address - Street 1:56 GRAND VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3756
Mailing Address - Country:US
Mailing Address - Phone:716-984-7840
Mailing Address - Fax:
Practice Address - Street 1:646 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1802
Practice Address - Country:US
Practice Address - Phone:716-984-7840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-18
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249117-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty