Basic Information
| Provider Information | |||||||||
| NPI: | 1972736825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUBE-MARCHANT | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPA-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MARCHANT | ||||||||
| OtherFirstName: | DEREK | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | MR. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166367990 | ||||||||
| FaxNumber: | 7166367993 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 E ROBINSON RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142282041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165641111 | ||||||||
| FaxNumber: | 7165641128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2009 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 013319-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.