Healthcare Provider Details

I. General information

NPI: 1467464131
Provider Name (Legal Business Name): ANTHONY MICHAEL MAROLDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 WESTFALL RD BLDG C-STE 220
ROCHESTER NY
14618-2638
US

IV. Provider business mailing address

PO BOX 278984
ROCHESTER NY
14627-8984
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7500
  • Fax: 585-756-2311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number242124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: