Provider Demographics
NPI:1689986317
Name:DAVID S BEVILACQUA MD PC
Entity Type:Organization
Organization Name:DAVID S BEVILACQUA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:BEVILACQUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-662-8089
Mailing Address - Street 1:S-3673 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1740
Mailing Address - Country:US
Mailing Address - Phone:716-662-8089
Mailing Address - Fax:
Practice Address - Street 1:S-3673 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1740
Practice Address - Country:US
Practice Address - Phone:716-662-8087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty