Provider Demographics
NPI:1619901170
Name:VASTOLA, CARY FRANK (DO)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:FRANK
Last Name:VASTOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-839-8000
Mailing Address - Fax:
Practice Address - Street 1:30 N UNION RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5367
Practice Address - Country:US
Practice Address - Phone:716-839-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6405734OtherIHA PROVIDER ID
NY00010182702OtherUNIVERA PROVIDER ID
NY000508092002OtherBLUECROSS BLUESHIELD ID
NY000508092002OtherBLUECROSS BLUESHIELD ID
NY6405734OtherIHA PROVIDER ID