Provider Demographics
NPI:1346219847
Name:WOPPERER, PAUL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:WOPPERER
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 1:5214 MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5373
Mailing Address - Country:US
Mailing Address - Phone:716-688-4473
Mailing Address - Fax:716-565-3624
Practice Address - Street 1:5214 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5373
Practice Address - Country:US
Practice Address - Phone:716-565-3620
Practice Address - Fax:716-565-3624
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000891Medicare ID - Type Unspecified
NYE35939Medicare UPIN