Individual
THEODORE VON WELLS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6000 N BAILEY AVE, AMHERST, NY 14226-5102
(716) 834-6152
(716) 834-5755
Mailing address
6000 N BAILEY AVE, AMHERST, NY 14226-5102
(716) 834-6152
(716) 834-5755
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
194653
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010305402
UNIVERA
NY
01
—
000524945009
BC/BS
NY
05
—
01772027
—
NY
01
—
2309846
IHA
NY
Enumeration date
11/07/2005
Last updated
09/09/2014
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