Provider Demographics
NPI:1568523058
Name:YOSUICO, VICTOR ERNESTO DAVID (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ERNESTO DAVID
Last Name:YOSUICO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-857-8666
Practice Address - Fax:716-857-8944
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY241989207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2714129OtherINDEPENDENT HEALTH
NY161000580OtherNOVA
NY161000580OtherEMPIRE
NY00027890801OtherUNIVERA
NY161000580OtherMERITAIN
NY000529004001OtherHEALTH NOW
NY02830880Medicaid