Healthcare Provider Details

I. General information

NPI: 1972739829
Provider Name (Legal Business Name): DANIELLE MARIE WILBUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 05/15/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE,
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVE, BOX 665
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-3385
  • Fax: 585-275-4057
Mailing address:
  • Phone: 585-273-3385
  • Fax: 585-275-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number280741
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number280741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: