Provider Demographics
NPI:1366413734
Name:TIRONE, CHARLES S (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:TIRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:405 N FRENCH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2010
Mailing Address - Country:US
Mailing Address - Phone:716-689-1901
Mailing Address - Fax:716-564-0209
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-649-9000
Practice Address - Fax:716-649-9005
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097861-12085B0100X
NY0978612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149934FFOtherPREFERRED CARE
NY000507061006OtherBCBS
NY1609206OtherINDEPENDENT HEALTH
NY00673776Medicaid
NY060530000067OtherFIDELIS OF NEW YORK
NY00026748305OtherUNIVERA HEALTHCARE
NYP00135324OtherRR MEDICARE
NYRA2069Medicare PIN
NY00026748305OtherUNIVERA HEALTHCARE
NY060530000067OtherFIDELIS OF NEW YORK
NY00673776Medicaid