Provider Demographics
NPI:1215919857
Name:DIFRANCESCO, GREGORY CHARLES (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:DIFRANCESCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3442
Mailing Address - Country:US
Mailing Address - Phone:716-662-3876
Mailing Address - Fax:
Practice Address - Street 1:529 CENTRAL AVE
Practice Address - Street 2:BROOKS MEMORIAL HOSPITAL
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2514
Practice Address - Country:US
Practice Address - Phone:716-363-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427774207P00000X
NY214943-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY214943-1OtherNY MEDICAL LICENSE
PAMD427774OtherPA MEDICAL LICENSE
PA098141Medicare ID - Type Unspecified
NY214943-1OtherNY MEDICAL LICENSE