Healthcare Provider Details

I. General information

NPI: 1669474854
Provider Name (Legal Business Name): MICHELLE CARPENTER-BRADLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7870
  • Fax: 585-723-7871
Mailing address:
  • Phone: 585-723-7870
  • Fax: 585-723-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number160634-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: