Healthcare Provider Details

I. General information

NPI: 1083641815
Provider Name (Legal Business Name): ROXANA VLAD-VONICA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROXANA VLAD MD

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GENESEE ST BLDG 1
ROCHESTER NY
14611-3201
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-3591
  • Fax: 585-368-3337
Mailing address:
  • Phone: 585-368-3172
  • Fax: 585-368-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number251281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: