Provider Demographics
NPI:1669842787
Name:CHU, THOMAS WAITAO (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WAITAO
Last Name:CHU
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 1:875 ELLICOTT ST
Mailing Address - Street 2:CTRC RM 6080
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1070
Mailing Address - Country:US
Mailing Address - Phone:716-645-8990
Mailing Address - Fax:
Practice Address - Street 1:875 ELLICOTT ST
Practice Address - Street 2:CTRC RM 6080
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1070
Practice Address - Country:US
Practice Address - Phone:716-645-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280101207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology