Provider Demographics
NPI:1811966799
Name:LARGO, DONALD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LARGO
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 1:275 NORTHPOINTE PKWY
Mailing Address - Street 2:STE 50
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1895
Mailing Address - Country:US
Mailing Address - Phone:716-834-1191
Mailing Address - Fax:
Practice Address - Street 1:1 COLOMBA DR
Practice Address - Street 2:STE 1
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1275
Practice Address - Country:US
Practice Address - Phone:716-282-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01129524Medicaid
NY602388900OtherDEPARTMENT OF LABOR
NY00010099504OtherUNIVERA
NY000525016003OtherBLUE CROSS
NY050112000105OtherFIDELIS
NY1703037OtherINDEPENDENT HEALTH
NY152342FLOtherPREFERRED CARE
P00228108OtherRAILROAD MEDICARE
NY152342FLOtherPREFERRED CARE
NY1703037OtherINDEPENDENT HEALTH