Provider Demographics
NPI:1851480222
Name:OSWARI, DICKY SR (MD)
Entity Type:Individual
Prefix:MR
First Name:DICKY
Middle Name:
Last Name:OSWARI
Suffix:SR
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 1:19 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:94105
Mailing Address - Country:US
Mailing Address - Phone:716-735-9922
Mailing Address - Fax:
Practice Address - Street 1:19 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:94105
Practice Address - Country:US
Practice Address - Phone:716-735-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115632208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010132101OtherUNIVERA
05067721OtherCOMMUNITY BC
6403597OtherINDEPENDENT
067221Medicare ID - Type Unspecified
6403597OtherINDEPENDENT