MEDICARE: THADDEUS JEFFREY DMOCHOWSKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	123719	NY
2	208C00000X	Colon & Rectal Surgery Physician	123719	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD4891	OTHER	NY	PREFERRED CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4471447	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1033179445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS JEFFREY DMOCHOWSKI M.D.

Provider Business Mailing Address
First Line	:	125 LATTIMORE RD
Second Line	:	SUITE 270
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4159
Country	:	US
Telephone Number	:	585-442-2075
Fax Number	:	585-244-4298

Provider Business Practice Location Address
First Line	:	1736 RIDGE RD E
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2157
Country	:	US
Telephone Number	:	585-266-8401
Fax Number	:	585-255-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	09/11/2025

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