Healthcare Provider Details

I. General information

NPI: 1164909776
Provider Name (Legal Business Name): ADNAN KHARSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADNAN MOHAMED BAKER KHARSA

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 S CLINTON AVE STE 100
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-5320
  • Fax: 585-442-5526
Mailing address:
  • Phone: 585-922-5462
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number311207
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number311207
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number311207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: