Basic Information
| Provider Information | |||||||||
| NPI: | 1801448436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUSHAL | ||||||||
| FirstName: | VAIBHAV | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 462 GRIDER ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142153098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168983000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 462 GRIDER ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142153098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2019 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4351044682 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 4301507442 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.