Healthcare Provider Details

I. General information

NPI: 1205893468
Provider Name (Legal Business Name): KATE G ACKERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 703
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 703
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-4001
  • Fax:
Mailing address:
  • Phone: 585-276-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number245557
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number160528
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: