MEDICARE: PARKER CHARLES REMELT

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	363A00000X	Physician Assistant	023768	NY

General Provider Information

NPI Number	:	1922650183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARKER CHARLES REMELT

Provider Business Mailing Address
First Line	:	400 WHITE SPRUCE BLVD STE B
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1619
Country	:	US
Telephone Number	:	585-275-2838
Fax Number	:	585-424-1338

Provider Business Practice Location Address
First Line	:	400 WHITE SPRUCE BLVD STE B
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1619
Country	:	US
Telephone Number	:	585-275-2838
Fax Number	:	585-424-1338

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	08/01/2019

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Directions to “ PARKER CHARLES REMELT ” Practice Location

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