Provider Demographics
NPI:1407152697
Name:ELGERSMA, CHADWIN CARTER (DO)
Entity Type:Individual
Prefix:
First Name:CHADWIN
Middle Name:CARTER
Last Name:ELGERSMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 HARLEM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1946
Mailing Address - Country:US
Mailing Address - Phone:716-836-7510
Mailing Address - Fax:716-832-3540
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-836-7510
Practice Address - Fax:716-832-3540
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263976207L00000X
NY263976-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology