Provider Demographics
NPI:1912958984
Name:ZGODA, VIRGINIA J (PA)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:J
Last Name:ZGODA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 BRIDLEWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2036
Mailing Address - Country:US
Mailing Address - Phone:716-741-7743
Mailing Address - Fax:
Practice Address - Street 1:8995 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1927
Practice Address - Country:US
Practice Address - Phone:716-634-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008897363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP67816Medicare UPIN
NYPA0304Medicare PIN