Individual
AVTAR S SAMRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 TWO MILE CREEK RD, TONAWANDA, NY 14150-6618
(716) 447-6450
(716) 447-6486
Mailing address
300 TWO MILE CREEK RD, TONAWANDA, NY 14150-6618
(716) 447-6450
(716) 447-6486
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
189530
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010156101
UNIVERA HEALTHCARE
NY
01
—
000523654001
BLUE CROSS OF WNY
NY
01
—
040426000412
FIDELIS
NY
01
—
1207083
INDEPENDENT HEALTH
NY
Enumeration date
07/19/2006
Last updated
07/08/2007
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