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Organization

ROBERT G FUGITT, MD & DAVID B LILLIE, MD, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT G FUGITT M.D. (PRESIDENT)
(716) 873-3828
Entity
Organization

Contact information

Practice address
3800 DELAWARE AVE, SUITE 104, KENMORE, NY 14217-1094
(716) 873-3828
Mailing address
400 INTERNATIONAL DR, WILLIAMSVILLE, NY 14221-5771
(716) 631-3555

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00010058801
UNIVERA
NY
01
00010104801
UNIVERA
NY
01
005006071
BLUE CROSS & BLUE SHIELD
NY
01
005082205
BLUE CROSS & BLUE SHIELD
NY
05
00607167
NY
05
00653136
NY
01
040426000254
FIDELIS CARE
NY
01
040426001716
FIDELIS CARE
NY
01
120597-0
WORKERS COMPENSATION
NY
01
145776-1
WORKERS COMPENSATION
NY
01
1900426
INDEPENDENT HEALTH
NY
01
1901010
INDEPENDENT HEALTH
NY
01
45488
GHI
NY
01
99321
GHI
NY
Enumeration date
04/10/2006
Last updated
08/19/2019
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