Healthcare Provider Details

I. General information

NPI: 1578671301
Provider Name (Legal Business Name): ANGELO J PEDULLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE BOX 15
ROCHESTER NY
14620
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 679-B
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-6780
  • Fax: 585-341-8489
Mailing address:
  • Phone: 585-341-6780
  • Fax: 585-341-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number250742
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number250742
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number250742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: