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NPI Code Detail

MEDICARE: KATRINA BUCKLAEW PA

MEDICARE: KATRINA BUCKLAEW PA
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
1363AM0700XMedical Physician Assistant025254NY
2363AS0400XSurgical Physician Assistant025254NY

General Provider Information

NPI Number : 1881202158
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRINA BUCKLAEW PA
Provider Business Mailing Address
First Line : 1425 PORTLAND AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-3011
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1425 PORTLAND AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-3011
Country : US
Telephone Number : 585-922-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2020
Last Update Date : 01/25/2026

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Directions to “ KATRINA BUCKLAEW PA” Practice Location

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