Healthcare Provider Details

I. General information

NPI: 1194755199
Provider Name (Legal Business Name): GUNHILDE M BUCHSBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RED CREEK DR STE 120
ROCHESTER NY
14623-4284
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-256-3887
  • Fax: 585-256-3508
Mailing address:
  • Phone: 585-275-0638
  • Fax: 585-273-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number192376
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number192376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: