Healthcare Provider Details

I. General information

NPI: 1487113742
Provider Name (Legal Business Name): ROBIN GARRICK WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE # 646
ROCHESTER NY
14642-0002
US

IV. Provider business mailing address

601 ELMWOOD AVE # 646
ROCHESTER NY
14642-0002
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-4711
  • Fax:
Mailing address:
  • Phone: 585-275-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number317750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: