MEDICARE: DR. MICHAEL BENJAMIN BOBROW MD

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	207NP0225X	Pediatric Dermatology Physician	210151	NY
2	207NS0135X	Procedural Dermatology Physician	210151	NY
3	207N00000X	Dermatology Physician	210151	NY

General Provider Information

NPI Number	:	1467416768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BENJAMIN BOBROW MD

Provider Business Mailing Address
First Line	:	120 ERIE CANAL DR STE 200
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4609
Country	:	US
Telephone Number	:	585-719-9600
Fax Number	:	585-719-9872

Provider Business Practice Location Address
First Line	:	120 ERIE CANAL DR STE 200
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4609
Country	:	US
Telephone Number	:	585-719-9600
Fax Number	:	585-719-9872

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	11/10/2023

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