Individual
CRAIG M FETTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2950 ELMWOOD AVE, KENMORE, NY 14217-1304
(716) 634-8800
(716) 634-8987
Mailing address
40 MAIN ST, HAMBURG, NY 14075-4948
(716) 649-0887
(716) 646-4611
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
230757
NY
208M00000X
Hospitalist Physician
Primary
230757-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000527760001
BC/BS
NY
01
—
0026827302
UNIVERA
NY
05
—
02533062
—
NY
01
—
041006000116
FIDELIS
NY
01
—
0412489
INDEPENDENT HEALTH
NY
Enumeration date
04/03/2006
Last updated
08/26/2022
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