Provider Demographics
NPI:1740244797
Name:WAZ, WAYNE RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:RICHARD
Last Name:WAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0140
Mailing Address - Fax:716-323-0292
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0140
Practice Address - Fax:716-323-0292
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1796212080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000528205001OtherBCBS OF WNY
NY01291905Medicaid
4808929OtherINDEPENDENT HEALTH ASSOC.
00010186301OtherUNIVERA HEALTHCARE
PA0014731570001OtherPENNSYLVANIA MEDICAID
040426001500OtherFIDELISCARE NY
PA0014731570001Medicaid
PA0014731570001OtherPENNSYLVANIA MEDICAID
000528205001OtherBCBS OF WNY