Provider Demographics
NPI:1194796482
Name:PERSAUD, ANDRE A (MD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:A
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2125
Mailing Address - Country:US
Mailing Address - Phone:716-366-4210
Mailing Address - Fax:716-366-3549
Practice Address - Street 1:306 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2125
Practice Address - Country:US
Practice Address - Phone:716-366-4210
Practice Address - Fax:716-366-3549
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY151520207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426003767OtherFIDELIS
NY00865247Medicaid
NY0703196OtherINDEPENDENT HEALTH
NY0001013710OtherUNIVERA
NY00500746OtherBLUE CROSS BLUE SHIELD
NY000000081723OtherGHI HMO
NY53221BMedicare ID - Type Unspecified
NY00500746OtherBLUE CROSS BLUE SHIELD