Healthcare Provider Details

I. General information

NPI: 1174553457
Provider Name (Legal Business Name): CARLOS PALACIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD INTENSIVE CARE
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

1555 LONG POND RD INTENSIVE CARE
ROCHESTER NY
14626-4122
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7000
  • Fax:
Mailing address:
  • Phone: 585-723-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number174493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: