Provider Demographics
NPI:1972736825
Name:AUBE-MARCHANT, DEREK M (RPA-C)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:M
Last Name:AUBE-MARCHANT
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:MR
Other - First Name:DEREK
Other - Middle Name:M
Other - Last Name:MARCHANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 YOUNGS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8053
Mailing Address - Country:US
Mailing Address - Phone:716-636-7990
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:3950 E ROBINSON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2041
Practice Address - Country:US
Practice Address - Phone:716-564-1111
Practice Address - Fax:716-564-1128
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013319-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant