Provider Demographics
NPI:1700390770
Name:FATIMA, UMBRINE (MD)
Entity Type:Individual
Prefix:
First Name:UMBRINE
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2004
Mailing Address - Country:US
Mailing Address - Phone:716-407-3250
Mailing Address - Fax:716-954-7117
Practice Address - Street 1:9650 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2004
Practice Address - Country:US
Practice Address - Phone:716-407-3250
Practice Address - Fax:716-954-7117
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294888207R00000X
FL71380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine