Provider Demographics
NPI:1144295056
Name:LA DUCA, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LA DUCA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4535 SOUTHWESTERN BLVD
Mailing Address - Street 2:UNIT 202
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1860
Mailing Address - Country:US
Mailing Address - Phone:716-662-2595
Mailing Address - Fax:716-662-0112
Practice Address - Street 1:4535 SOUTHWESTERN BLVD
Practice Address - Street 2:UNIT 202
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-662-2595
Practice Address - Fax:716-662-0112
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-04-04
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Provider Licenses
StateLicense IDTaxonomies
NY111366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00615361Medicaid
NYB71467Medicare UPIN
NY00615361Medicaid