Provider Demographics
NPI:1497916431
Name:CIRILLO, DOMINIC J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:J
Last Name:CIRILLO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 BRIARHURST DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8837
Mailing Address - Country:US
Mailing Address - Phone:319-321-5451
Mailing Address - Fax:844-373-1861
Practice Address - Street 1:175 BRIARHURST DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:319-321-5451
Practice Address - Fax:844-373-1861
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8428207R00000X
NY285631207R00000X, 2083P0901X
IA40121208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice