Healthcare Provider Details

I. General information

NPI: 1649277963
Provider Name (Legal Business Name): TIMOTHY J CLADER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HAGEN DR SUITE 110
ROCHESTER NY
14625-2657
US

IV. Provider business mailing address

20 HAGEN DR SUITE 110
ROCHESTER NY
14625-2657
US

V. Phone/Fax

Practice location:
  • Phone: 585-218-9651
  • Fax: 585-267-4037
Mailing address:
  • Phone: 585-218-9651
  • Fax: 585-267-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number154267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: