Provider Demographics
NPI:1043208622
Name:SAME, J. BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:J. BRIAN
Middle Name:
Last Name:SAME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2007
Mailing Address - Country:US
Mailing Address - Phone:716-883-6800
Mailing Address - Fax:716-883-6853
Practice Address - Street 1:897 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2007
Practice Address - Country:US
Practice Address - Phone:716-883-6800
Practice Address - Fax:716-883-6853
Is Sole Proprietor?:No
Enumeration Date:2005-10-08
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1516221173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010155901OtherUNIVERA
NY1002486OtherINDEPENDENT HEALTH
NY0046122OtherGHI
NY000502673001OtherBLUE CROSS/BLUE SHIELD
NY01049063Medicaid
NY01049063Medicaid
NYD01416Medicare UPIN