Basic Information
Provider Information | |||||||||
NPI: | 1952309544 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DEVER | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | P | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 8000 | ||||||||
Address2: | DEPT. 441 | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142670002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168445600 | ||||||||
FaxNumber: | 7168445750 | ||||||||
Practice Location | |||||||||
Address1: | 995 SENATOR KEATING BLVD. | ||||||||
Address2: | BLDG. E STE 330 | ||||||||
City: | ROCHESTER | ||||||||
State: | NY | ||||||||
PostalCode: | 146182775 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5852322980 | ||||||||
FaxNumber: | 5852326522 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2005 | ||||||||
LastUpdateDate: | 04/18/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 146560 | NY | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 1990211 | 01 | NY | IHA | OTHER | 41123000044 | 01 | NM | FIDELIS | OTHER | 73110 | 01 | NM | GHI | OTHER | 912143 | 05 | NY |   | MEDICAID | MD476A | 01 | NY | PREFERED CARE | OTHER | 332089 | 01 | NY | WELL CARE | OTHER | 912908001 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 20945001 | 01 | NY | UNIVERA | OTHER | 91290801 | 01 | NY | HEALTH NOW | OTHER |