Provider Demographics
NPI:1558379297
Name:VIVONA, JOAN ANN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ANN
Last Name:VIVONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 ABBOTT RD
Mailing Address - Street 2:MERCY HOSPITAL OF BUFFALO
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2039
Mailing Address - Country:US
Mailing Address - Phone:716-826-7000
Mailing Address - Fax:
Practice Address - Street 1:400 NORTHRUP RD
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9623
Practice Address - Country:US
Practice Address - Phone:716-879-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164969-1207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01842846Medicaid
NY01842846Medicaid