Basic Information
| Provider Information | |||||||||
| NPI: | 1366413734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIRONE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 N FRENCH RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142282010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166891901 | ||||||||
| FaxNumber: | 7165640209 | ||||||||
| Practice Location | |||||||||
| Address1: | 2157 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142142648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166499000 | ||||||||
| FaxNumber: | 7166499005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 08/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 097861-1 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 097861 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 149934FF | 01 | NY | PREFERRED CARE | OTHER | 000507061006 | 01 | NY | BCBS | OTHER | 1609206 | 01 | NY | INDEPENDENT HEALTH | OTHER | 00673776 | 05 | NY | MEDICAID | 060530000067 | 01 | NY | FIDELIS OF NEW YORK | OTHER | 00026748305 | 01 | NY | UNIVERA HEALTHCARE | OTHER | P00135324 | 01 | NY | RR MEDICARE | OTHER |