Healthcare Provider Details

I. General information

NPI: 1063584977
Provider Name (Legal Business Name): JOAN W CHISHOLM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 SOUTH AVE SUITE 103
ROCHESTER NY
14620-2740
US

IV. Provider business mailing address

990 SOUTH AVE SUITE 103
ROCHESTER NY
14620-2740
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-0101
  • Fax: 585-341-0161
Mailing address:
  • Phone: 585-341-0101
  • Fax: 585-341-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number157500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: