Provider Demographics
NPI:1841256468
Name:CELLINO, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:CELLINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:STE 108
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4825
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:3345 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1506
Practice Address - Country:US
Practice Address - Phone:716-656-4803
Practice Address - Fax:716-250-5932
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2016-06-22
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Provider Licenses
StateLicense IDTaxonomies
NY1423257-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000100279OtherUNIVERA
NY060011234OtherRR MEDICARE
NY161000580OtherEMPIRE
NY0402629OtherIHA
NY01139844Medicaid
NY161000580OtherNORTH AMERICAN PREFERRED
NY000508528003OtherHEALTH NOW
NY143257-4WOtherWORKERS COMPENSATION
NY161000580OtherNORTH AMERICAN PREFERRED
NYE15425Medicare UPIN