Healthcare Provider Details

I. General information

NPI: 1831128545
Provider Name (Legal Business Name): JAHAN PORHOMAYON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVENUE
ROCHESTER NY
14621-3008
US

IV. Provider business mailing address

1415 PORTLAND AVE SUITE 245
ROCHESTER NY
14621-3038
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4874
  • Fax:
Mailing address:
  • Phone: 585-922-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number196662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: