Healthcare Provider Details

I. General information

NPI: 1366821209
Provider Name (Legal Business Name): PATRICK ABT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 S CLINTON AVE
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:
Mailing address:
  • Phone: 585-922-1203
  • Fax: 585-922-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number263562
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number309462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: