Provider Demographics
NPI:1073544755
Name:UPDIKE, PAUL F (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:UPDIKE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2648
Mailing Address - Country:US
Mailing Address - Phone:716-893-8550
Mailing Address - Fax:716-893-4020
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-893-8550
Practice Address - Fax:716-893-4020
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211389207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525221003OtherBLUE CROSS OF WNY
NY00010368201OtherUNIVERA
NY0410078OtherINDEPENDENT HEALTH
NY0410078OtherINDEPENDENT HEALTH
NYBB1954Medicare ID - Type UnspecifiedMEDICARE B