Healthcare Provider Details

I. General information

NPI: 1891069225
Provider Name (Legal Business Name): NICOLE DANIELLE PECORA MD/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE UNIVERSITY OF ROCHESTER MEDICAL CENTER, BOX 626
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVENUE URMC BOX 626
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3184
  • Fax: 585-276-2047
Mailing address:
  • Phone: 585-275-3184
  • Fax: 585-276-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number249090
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number283851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: