Provider Demographics
NPI:1346411675
Name:SALEH A. FETOUH, M.D., PC
Entity Type:Organization
Organization Name:SALEH A. FETOUH, M.D., PC
Other - Org Name:BREAST SCREENING CENTER OF WNY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FETOUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-838-1300
Mailing Address - Street 1:2828 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1722
Mailing Address - Country:US
Mailing Address - Phone:716-838-1300
Mailing Address - Fax:716-837-7725
Practice Address - Street 1:2828 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1722
Practice Address - Country:US
Practice Address - Phone:716-838-1300
Practice Address - Fax:716-837-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography