Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 146100 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 146100 | NY |
NPI | 1255324547 |
---|---|
Provider Name | Richard D Blondell |
First Address | Amherst, NY 14228-2783 |
Second Address | Amherst, NY 14228-2783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02364616 | (05) | NY |
B42634 | (02) |