Healthcare Provider Details

I. General information

NPI: 1255424396
Provider Name (Legal Business Name): HIROSHI MIYAMOTO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/06/2023
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 AVE URMC BOX 626
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-8748
  • Fax: 585-273-3637
Mailing address:
  • Phone: 585-275-3184
  • Fax: 585-276-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number249669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: