Provider Demographics
NPI:1922039213
Name:SIAW, PATRICK A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:SIAW
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 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2648
Mailing Address - Country:US
Mailing Address - Phone:716-862-1984
Mailing Address - Fax:716-862-1891
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-862-1984
Practice Address - Fax:716-862-1891
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010370101OtherUNIVERA
NY000525325005OtherBLUE CROSS OF WNY
NY0410363OtherINDEPENDENT HEALTH
NY0410363OtherINDEPENDENT HEALTH
G88990Medicare UPIN