Healthcare Provider Details

I. General information

NPI: 1376589721
Provider Name (Legal Business Name): MICHELLE L CHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 RIDGEWAY AVE SUITE 180
ROCHESTER NY
14626-4285
US

IV. Provider business mailing address

2655 RIDGEWAY AVE SUITE 180
ROCHESTER NY
14626-4285
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4000
  • Fax: 585-225-2685
Mailing address:
  • Phone: 585-368-4000
  • Fax: 585-225-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number217373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: