MEDICARE: DR. GRAMA SITHARAM JAGADISH 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	207R00000X	Internal Medicine Physician	163052	NY

General Provider Information

NPI Number	:	1194794073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRAMA SITHARAM JAGADISH M.D

Provider Business Mailing Address
First Line	:	1401 STONE RD
Second Line	:	SUITE 103
City	:	ROCHESTER
State	:	NY
Zip	:	14615-1537
Country	:	US
Telephone Number	:	585-663-3720
Fax Number	:	585-663-8391

Provider Business Practice Location Address
First Line	:	1401 STONE RD
Second Line	:	SUITE 103
City	:	ROCHESTER
State	:	NY
Zip	:	14615-1537
Country	:	US
Telephone Number	:	585-663-3720
Fax Number	:	585-663-8391

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/19/2022

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