Individual
THOMAS BEVILACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221-3178
(716) 836-4646
(716) 836-4696
Mailing address
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221-3178
(716) 836-4646
(716) 836-4696
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
125.060174
IL
2085R0202X
Diagnostic Radiology Physician
Primary
288107
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04873929
—
NY
Enumeration date
08/08/2011
Last updated
08/18/2023
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