Healthcare Provider Details

I. General information

NPI: 1760666770
Provider Name (Legal Business Name): ALEXANDRA VLADIMIR YAMSHCHIKOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX MED
ROCHESTER NY
14642-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-0526
  • Fax: 585-273-1055
Mailing address:
  • Phone: 585-275-0526
  • Fax: 585-273-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number057863
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number256497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: