Provider Demographics
NPI:1497718464
Name:ROBERT G FUGITT, MD & DAVID B LILLIE, MD, PC
Entity Type:Organization
Organization Name:ROBERT G FUGITT, MD & DAVID B LILLIE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FUGITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-873-3828
Mailing Address - Street 1:400 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5771
Mailing Address - Country:US
Mailing Address - Phone:716-631-3555
Mailing Address - Fax:
Practice Address - Street 1:3800 DELAWARE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1094
Practice Address - Country:US
Practice Address - Phone:716-873-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005082205OtherBLUE CROSS & BLUE SHIELD
NY00653136Medicaid
NY040426001716OtherFIDELIS CARE
NY040426000254OtherFIDELIS CARE
NY1900426OtherINDEPENDENT HEALTH
NY45488OtherGHI
NY120597-0OtherWORKERS COMPENSATION
NY145776-1OtherWORKERS COMPENSATION
NY00010104801OtherUNIVERA
NY00607167Medicaid
NY99321OtherGHI
NY00010058801OtherUNIVERA
NY005006071OtherBLUE CROSS & BLUE SHIELD
NY1901010OtherINDEPENDENT HEALTH
NY145776-1OtherWORKERS COMPENSATION
NY005082205OtherBLUE CROSS & BLUE SHIELD
NY040426001716OtherFIDELIS CARE