Healthcare Provider Details

I. General information

NPI: 1366457814
Provider Name (Legal Business Name): MANASI KADAM LADRIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANASI ARUN KADAM MD

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WINTON RD S
ROCHESTER NY
14618-1628
US

IV. Provider business mailing address

900 WINTON RD S
ROCHESTER NY
14618-1628
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-5800
  • Fax: 585-348-9461
Mailing address:
  • Phone: 585-381-5800
  • Fax: 585-348-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number242371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: