Individual
MAHESH BOMMARAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 MAPLE RD, WILLIAMSVILLE, NY 14221-3647
(716) 878-7662
Mailing address
219 BRYANT ST, BUFFALO, NY 14222-2006
(716) 878-7673
(716) 878-7945
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
190900
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010018901
UNIVERA
—
01
—
000523290004
BC/BS
—
05
—
01564185
—
NY
01
—
040426000926
FIDELIS
—
01
—
3610082
IHA
—
Enumeration date
03/02/2006
Last updated
01/11/2010
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