Healthcare Provider Details

I. General information

NPI: 1164433249
Provider Name (Legal Business Name): RALF THIELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RED CREEK DR SUITE 240
ROCHESTER NY
14623-4273
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX MED
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-486-0901
  • Fax: 585-340-5399
Mailing address:
  • Phone: 585-275-6275
  • Fax: 585-276-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07649400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number241557
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA07649400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: