MEDICARE: PASQUALE IANNOLI 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	197775	NY

General Provider Information

NPI Number	:	1538160940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PASQUALE IANNOLI M.D.

Provider Business Mailing Address
First Line	:	99 CANAL LANDING BLVD
Second Line	:	SUITE 6
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5112
Country	:	US
Telephone Number	:	585-247-4770
Fax Number	:	585-247-4268

Provider Business Practice Location Address
First Line	:	99 CANAL LANDING BLVD
Second Line	:	SUITE 6
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5112
Country	:	US
Telephone Number	:	585-247-4770
Fax Number	:	585-247-4268

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/24/2020

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