Healthcare Provider Details

I. General information

NPI: 1740757889
Provider Name (Legal Business Name): MS. HANNAH CHARLENE KOTERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 07/03/2023
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 665
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-9640
  • Fax:
Mailing address:
  • Phone: 585-341-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number25062
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: