Healthcare Provider Details

I. General information

NPI: 1801894100
Provider Name (Legal Business Name): LOUIS HOWARD MEDVED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ERIE CANAL DR SUITE G
ROCHESTER NY
14626-4604
US

IV. Provider business mailing address

30 ERIE CANAL DR SUITE G
ROCHESTER NY
14626-4604
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-3950
  • Fax: 585-227-9047
Mailing address:
  • Phone: 585-227-3950
  • Fax: 585-227-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number158941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: