Healthcare Provider Details

I. General information

NPI: 1093718470
Provider Name (Legal Business Name): PETER E. MULBURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 LINDEN OAKS DRIVE SUITE 220
ROCHESTER NY
14625
US

IV. Provider business mailing address

360 LINDEN OAKS DRIVE SUITE 220
ROCHESTER NY
14625
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-3510
  • Fax: 585-244-3519
Mailing address:
  • Phone: 585-244-3510
  • Fax: 585-244-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number112245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: