Healthcare Provider Details

I. General information

NPI: 1972615755
Provider Name (Legal Business Name): RYAN CONNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CANAL LANDING BLVD SUITE 8
ROCHESTER NY
14626-5109
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 585-239-7300
  • Fax: 585-227-7723
Mailing address:
  • Phone: 585-442-5320
  • Fax: 585-442-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248730
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number248730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: