Provider Demographics
NPI:1386604775
Name:CLIFFORD, DAVID S (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:CLIFFORD
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 1:256 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1947
Mailing Address - Country:US
Mailing Address - Phone:716-677-4469
Mailing Address - Fax:716-677-4470
Practice Address - Street 1:256 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1947
Practice Address - Country:US
Practice Address - Phone:716-677-4469
Practice Address - Fax:716-677-4470
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196229-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D0949003OtherCLIA
G00001OtherUPIN
NY01597039Medicaid
NY196229-1OtherLICENSE
NY16-1550816OtherTAX ID
NY16-1550816OtherTAX ID
NY01597039Medicaid