Healthcare Provider Details

I. General information

NPI: 1144310632
Provider Name (Legal Business Name): BRUCE SMOLLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/28/2023
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 Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberE-1327
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number168963
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number042.0012190
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE-1327
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number168963-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: