Provider Demographics
NPI:1881761559
Name:MCGRAVEY, VINCENT JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:MCGRAVEY
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 1:515 ABBOTT RD
Mailing Address - Street 2:STE 304
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-995-8801
Mailing Address - Fax:716-995-8810
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-828-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010114703OtherUNIVERA HEALTHCARE
NY000500289002OtherBLUE CROSS WNY
NY00010114702OtherUNIVERA HEALTHCARE
NY000500289005OtherBLUECROSSBLUESHIELD
NY00827385Medicaid
NY1203201OtherINDEPENDENT HEALTH
NY070520000000OtherFIDELIS CARE NY
NY040426002007OtherFIDELISCARE NY