Healthcare Provider Details

I. General information

NPI: 1245337047
Provider Name (Legal Business Name): MICHAEL E PICHICHERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S CLINTON AVE STE 360
ROCHESTER NY
14618
US

IV. Provider business mailing address

1815 S CLINTON AVE STE 360
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-568-8320
  • Fax: 585-568-8327
Mailing address:
  • Phone: 585-568-8330
  • Fax: 585-568-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number137099
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1370991
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number1370991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: