Healthcare Provider Details

I. General information

NPI: 1649396573
Provider Name (Legal Business Name): WESTSIDE PEDIATRIC GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 BEAHAN RD
ROCHESTER NY
14624-3403
US

IV. Provider business mailing address

497 BEAHAN RD
ROCHESTER NY
14624-3403
US

V. Phone/Fax

Practice location:
  • Phone: 585-247-5400
  • Fax: 585-319-4124
Mailing address:
  • Phone: 585-247-5400
  • Fax: 585-319-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number131798
License Number StateNY

VIII. Authorized Official

Name: DR. MOLLY E HUGHES
Title or Position: PARTNER/OWNER
Credential: MD
Phone: 585-247-5400