Provider Demographics
NPI:1811926249
Name:ONEIL, DAVID CHARLES (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:ONEIL
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2115
Mailing Address - Country:US
Mailing Address - Phone:716-649-4454
Mailing Address - Fax:716-649-4794
Practice Address - Street 1:3755 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2115
Practice Address - Country:US
Practice Address - Phone:716-649-4454
Practice Address - Fax:716-649-4794
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4911Medicaid
NYE35579Medicare UPIN
NYBB4911Medicaid