Healthcare Provider Details

I. General information

NPI: 1548270069
Provider Name (Legal Business Name): BRIAN DREW SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1000 SOUTH AVE BOX 67
ROCHESTER NY
14620-2733
US

IV. Provider business mailing address

1000 SOUTH AVE BOX 67
ROCHESTER NY
14620-2733
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-6622
  • Fax: 585-341-8236
Mailing address:
  • Phone: 585-341-6622
  • Fax: 585-341-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number138833
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number138833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: