Healthcare Provider Details

I. General information

NPI: 1215732664
Provider Name (Legal Business Name): DEREK MICHAEL VAN PEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVENUE BOX 626
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 626
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3197
  • Fax: 585-273-3637
Mailing address:
  • Phone: 585-275-3197
  • Fax: 585-273-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number327974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: