Provider Demographics
NPI:1982705745
Name:DAVID C. O'NEIL, MD PHD, PC
Entity type:Organization
Organization Name:DAVID C. O'NEIL, MD PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-649-4454
Mailing Address - Street 1:3755 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2115
Mailing Address - Country:US
Mailing Address - Phone:716-649-4454
Mailing Address - Fax:716-649-4794
Practice Address - Street 1:3755 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2115
Practice Address - Country:US
Practice Address - Phone:716-649-4454
Practice Address - Fax:716-649-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01074693Medicaid
NYBA1482Medicare PIN
E35579Medicare UPIN
BB4911Medicare ID - Type UnspecifiedMEDICARE PROVIDER #