Healthcare Provider Details

I. General information

NPI: 1215903562
Provider Name (Legal Business Name): JOHN D MARQUARDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD SUITE 100
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

125 LATTIMORE RD SUITE 100
ROCHESTER NY
14620-4159
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-1033
  • Fax: 585-473-8605
Mailing address:
  • Phone: 585-473-1033
  • Fax: 585-473-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number131494-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: