Provider Demographics
NPI:1346271590
Name:PLATA, EDWARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:T
Last Name:PLATA
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 1:56 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:716-836-7510
Mailing Address - Fax:
Practice Address - Street 1:2121 MAIN ST
Practice Address - Street 2:STE. 111
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2693
Practice Address - Country:US
Practice Address - Phone:716-836-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002079-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02593906Medicaid
NY02593906Medicaid
NYRA2893Medicare ID - Type Unspecified