Provider Demographics
NPI:1568688877
Name:BANGSIL, EDGAR LACSON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:LACSON
Last Name:BANGSIL
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 1:95 E CHAUTAUQUA ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1017
Mailing Address - Country:US
Mailing Address - Phone:716-753-7107
Mailing Address - Fax:
Practice Address - Street 1:845 ROUTE 5 & 20
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081
Practice Address - Country:US
Practice Address - Phone:716-951-7000
Practice Address - Fax:716-951-7168
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152589207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00741300Medicaid
B36174Medicare UPIN
NY152589Medicaid