Healthcare Provider Details

I. General information

NPI: 1134197387
Provider Name (Legal Business Name): EMMANUEL A QUAIDOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MERIDIAN CENTRE BLVD STE 300
ROCHESTER NY
14618-3984
US

IV. Provider business mailing address

10 HAGEN DR STE 330
ROCHESTER NY
14625-2661
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-0150
  • Fax: 585-271-8704
Mailing address:
  • Phone: 585-922-8350
  • Fax: 585-922-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number193211
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number193211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: