Healthcare Provider Details

I. General information

NPI: 1508177510
Provider Name (Legal Business Name): ANGELA ROSE GIRVIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

50 GOLDEN OAKS WAY
ROCHESTER NY
14624
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT197579
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number284821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: