Provider Demographics
NPI:1740241918
Name:NAUGHTON, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:NAUGHTON
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 1:100 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1126
Mailing Address - Country:US
Mailing Address - Phone:716-859-3876
Mailing Address - Fax:716-859-1491
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-3876
Practice Address - Fax:716-859-1491
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195956207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477696Medicaid
NY0407564OtherINDEPENDENT HEALTH
NY005232961OtherHEALTH NOW
NY00010125701OtherEXCELLUS UNIVERA
NY00010125701OtherEXCELLUS UNIVERA
110082361Medicare PIN
NY005232961OtherHEALTH NOW
BB1068Medicare ID - Type Unspecified