Healthcare Provider Details

I. General information

NPI: 1114079639
Provider Name (Legal Business Name): THOMAS O. MCMEEKIN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1606
US

IV. Provider business mailing address

300 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1606
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-6770
  • Fax: 585-424-6776
Mailing address:
  • Phone: 585-424-6770
  • Fax: 585-424-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number120151-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number230724
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number33554
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number197921-1
License Number StateNY

VIII. Authorized Official

Name: MRS. HEATHER MCKENZIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-424-6770