Healthcare Provider Details

I. General information

NPI: 1063435238
Provider Name (Legal Business Name): ROKSOLANA KUCHMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 RIDGEWAY AVE
ROCHESTER NY
14626-4127
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2440
  • Fax: 585-663-3293
Mailing address:
  • Phone: 585-922-1469
  • Fax: 585-922-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number249194
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number249194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: