Provider Demographics
NPI:1508933581
Name:SIRIANNI, SAMUEL R (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:R
Last Name:SIRIANNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLOMBA DR
Mailing Address - Street 2:STE #2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1205
Mailing Address - Country:US
Mailing Address - Phone:716-298-8400
Mailing Address - Fax:716-297-3546
Practice Address - Street 1:1 COLOMBA DR
Practice Address - Street 2:STE #2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1205
Practice Address - Country:US
Practice Address - Phone:716-298-8400
Practice Address - Fax:716-297-3546
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1676531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01114290Medicaid
A68553Medicare ID - Type Unspecified
NY01114290Medicaid