Healthcare Provider Details

I. General information

NPI: 1376501494
Provider Name (Legal Business Name): ROBERT BINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 RIDGEWAY AVE SUITE 220
ROCHESTER NY
14626-4296
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4560
  • Fax: 585-368-4565
Mailing address:
  • Phone: 585-922-1900
  • Fax: 585-922-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number197942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: