Provider Demographics
NPI:1881663144
Name:MAMNOON, SAMEER SHAMOON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:SHAMOON
Last Name:MAMNOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6645 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5934
Mailing Address - Country:US
Mailing Address - Phone:716-276-8726
Mailing Address - Fax:716-276-8730
Practice Address - Street 1:6645 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5934
Practice Address - Country:US
Practice Address - Phone:716-276-8726
Practice Address - Fax:716-276-8730
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0500OtherMEDICARE PTAN
NYBA0500OtherMEDICARE PTAN
NYH43536Medicare UPIN