Provider Demographics
NPI:1376629790
Name:TRIVEDI, JAGDISH M (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:JAGDISH
Middle Name:M
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NIAGRA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-284-2222
Mailing Address - Fax:
Practice Address - Street 1:817 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NIAGRA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-284-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126770208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010180101OtherUNIVERA
NY00506959001OtherBLUE CROSS BLUE SHIELD
NY00456859Medicaid
B36034Medicare UPIN
NY069591Medicare ID - Type Unspecified