Provider Demographics
NPI:1942495635
Name:DEIDRA WOMEN'S MEDICAL HEALTH SERVICES, PC
Entity Type:Organization
Organization Name:DEIDRA WOMEN'S MEDICAL HEALTH SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACOG
Authorized Official - Phone:716-366-5222
Mailing Address - Street 1:609 CENTRAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2538
Mailing Address - Country:US
Mailing Address - Phone:716-366-5222
Mailing Address - Fax:716-366-5224
Practice Address - Street 1:609 CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2538
Practice Address - Country:US
Practice Address - Phone:716-366-5222
Practice Address - Fax:716-366-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210392-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1164Medicare PIN