Healthcare Provider Details

I. General information

NPI: 1396721007
Provider Name (Legal Business Name): REBECCA D GARGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ASSEMBLY DR SUITE 101
MENDON NY
14506-9602
US

IV. Provider business mailing address

30 ASSEMBLY DR SUITE 101
MENDON NY
14506-9602
US

V. Phone/Fax

Practice location:
  • Phone: 585-624-4520
  • Fax: 585-624-4829
Mailing address:
  • Phone: 585-624-4520
  • Fax: 585-624-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number206259
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: