Healthcare Provider Details

I. General information

NPI: 1750816047
Provider Name (Legal Business Name): DOROTHY PAN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 S CLINTON AVE STE 200
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

105 MONTPELIER CIR
ROCHESTER NY
14618-5623
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number334614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: