Provider Demographics
NPI:1609869783
Name:SUDDABY, LOUBERT STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUBERT
Middle Name:STEVEN
Last Name:SUDDABY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 CAMP RD STE 400
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2600
Mailing Address - Country:US
Mailing Address - Phone:716-648-6875
Mailing Address - Fax:716-648-6939
Practice Address - Street 1:4855 CAMP RD STE 400
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2600
Practice Address - Country:US
Practice Address - Phone:716-648-6875
Practice Address - Fax:716-648-6939
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193722207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0002052461OtherUNIVERA
NY000523004003OtherBCBS
NY111253CGOtherPREFERRED CARE
NY0607039OtherINDEPENDENT HEALTH
NY140003497OtherRR MEDICARE
NY6001373OtherGROUP HEALTH INC
F66853Medicare UPIN
NYDD2299Medicare PIN
NY140003497OtherRR MEDICARE