Individual
ANDREA L. DEROSAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 FOREST AVE, BUFFALO, NY 14213-1207
(716) 816-2515
Mailing address
400 FOREST AVE, BUFFALO, NY 14213-1207
(716) 816-2515
(716) 816-2066
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
223237
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025948403
UNIVERA
NY
01
—
000526772003
BC/BS
NY
05
—
02282635
—
NY
01
—
0411408
IHA
NY
01
—
151079BJ
PREFERRED CARE
NY
Enumeration date
03/01/2006
Last updated
07/08/2007
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