Provider Demographics
NPI:1982920328
Name:PUVENDRAN, SAMUEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:N
Last Name:PUVENDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1470
Mailing Address - Country:US
Mailing Address - Phone:716-206-1550
Mailing Address - Fax:716-651-9855
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3445
Practice Address - Country:US
Practice Address - Phone:716-712-1030
Practice Address - Fax:716-651-9855
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY256609207R00000X, 207RC0200X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine