Provider Demographics
NPI:1376542753
Name:NIGAM, VINOD (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:
Last Name:NIGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:PO BOX 648
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8648
Mailing Address - Country:US
Mailing Address - Phone:585-275-2734
Mailing Address - Fax:585-273-1033
Practice Address - Street 1:1150 YOUNGS RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8053
Practice Address - Country:US
Practice Address - Phone:716-688-7622
Practice Address - Fax:716-688-7592
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2063492085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00040941407OtherUNIVERA/EXCELLUS #
NY5609957OtherINDEPENDENT HEALTH #
NYCR-DRA206349-3WOtherWORKERS COMPENSATION #
NY01748190Medicaid
NY300137047OtherRAIL ROAD MEDICARE
NY000525006020OtherBLUE CROSS WNY #
NY150590FFOtherPREFERRED CARE-ROCHESTER
NYG60593Medicare UPIN
NY01748190Medicaid