Healthcare Provider Details

I. General information

NPI: 1952339202
Provider Name (Legal Business Name): BARBARA M. WEDIG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 ISLAND COTTAGE RD
ROCHESTER NY
14612-2349
US

IV. Provider business mailing address

25 THRUSH FIELD WAY
PITTSFORD NY
14534-9526
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2610
  • Fax: 585-581-1396
Mailing address:
  • Phone: 585-218-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: