Provider Demographics
NPI:1205892171
Name:TYO, JOHN MARSHALL (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:TYO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4511 HARLEM ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:219 BRYANT STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7109
Practice Address - Fax:716-888-3874
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2138032080P0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3991525OtherIHA
000525797001OtherBC/BS
00020541001OtherUNIVERA
PA0018460620001Medicaid
NY01988229Medicaid
040426001680OtherFIDELIS
00020541001OtherUNIVERA
BB9273Medicare PIN