Healthcare Provider Details

I. General information

NPI: 1790791887
Provider Name (Legal Business Name): JAGDISH P MISHRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 SUMMIT ST STE 9
BATAVIA NY
14020-1645
US

IV. Provider business mailing address

229 SUMMIT ST STE 9
BATAVIA NY
14020-1645
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-3205
  • Fax: 585-343-5038
Mailing address:
  • Phone: 585-343-3205
  • Fax: 585-343-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number215983
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number215983
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: