Provider Demographics
NPI:1588637680
Name:BANCROFT, GEORGE H (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:BANCROFT
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 1:515 ABBOTT ROAD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220
Mailing Address - Country:US
Mailing Address - Phone:716-826-6628
Mailing Address - Fax:716-828-3448
Practice Address - Street 1:565 ABBOTT ROAD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220
Practice Address - Country:US
Practice Address - Phone:716-826-6628
Practice Address - Fax:716-828-3448
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1503691207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01504012Medicaid
NY01504012Medicaid
B71019Medicare UPIN