Provider Demographics
NPI:1699096289
Name:SALVADOR M UDAGAWA MD PC
Entity type:Organization
Organization Name:SALVADOR M UDAGAWA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:UDAGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-835-0641
Mailing Address - Street 1:3404 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1316
Mailing Address - Country:US
Mailing Address - Phone:716-835-0641
Mailing Address - Fax:716-835-3450
Practice Address - Street 1:3404 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1316
Practice Address - Country:US
Practice Address - Phone:716-835-0641
Practice Address - Fax:716-835-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117941208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010181001OtherUNIVERA
NY145044AOOtherPREFERRED CARE
NY000506064001OtherBLUE CROSS WNY
NY1406021OtherINDEPENDENT HEALTH