Provider Demographics
NPI:1104881408
Name:BOSSMAN, OWEN G (MD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:G
Last Name:BOSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-857-8944
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-857-8625
Practice Address - Fax:716-250-5961
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY090635-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0001001840OtherUNIVERA
NY00481085Medicaid
NY090635-4BOtherWORKERS COMPENSATION
NY2800146OtherIHA
NY000502176001OtherHEALTH NOW
NYC49506Medicare UPIN
NY000502176001OtherHEALTH NOW