Provider Demographics
NPI:1548395429
Name:PECORARO, SALVATORE RUSSELL (MD)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:RUSSELL
Last Name:PECORARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FORESTVIEW COURT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1445
Mailing Address - Country:US
Mailing Address - Phone:716-689-6765
Mailing Address - Fax:
Practice Address - Street 1:200 OHIO STREET
Practice Address - Street 2:MEDINA MEMORIAL HOSPITAL
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103
Practice Address - Country:US
Practice Address - Phone:585-798-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183816207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY183816Medicaid
BP2498182OtherDEA
E93745Medicare UPIN
NY183816Medicaid