Provider Demographics
NPI:1740413749
Name:DIAZ DEL CARPIO, ROBERTO ORLANDO
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ORLANDO
Last Name:DIAZ DEL CARPIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 MAIN ST STE 23
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3826
Mailing Address - Country:US
Mailing Address - Phone:716-871-1571
Mailing Address - Fax:
Practice Address - Street 1:900 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2611
Practice Address - Country:US
Practice Address - Phone:716-871-1571
Practice Address - Fax:716-871-1580
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272608207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine