Basic Information
| Provider Information | |||||||||
| NPI: | 1740244797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAZ | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163230140 | ||||||||
| FaxNumber: | 7163230292 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163230140 | ||||||||
| FaxNumber: | 7163230292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | 179621 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 000528205001 | 01 | BCBS OF WNY | OTHER | 01291905 | 05 | NY | MEDICAID | 4808929 | 01 | INDEPENDENT HEALTH ASSOC. | OTHER | 00010186301 | 01 | UNIVERA HEALTHCARE | OTHER | 0014731570001 | 01 | PA | PENNSYLVANIA MEDICAID | OTHER | 040426001500 | 01 | FIDELISCARE NY | OTHER | 0014731570001 | 05 | PA | MEDICAID |