Healthcare Provider Details

I. General information

NPI: 1548536998
Provider Name (Legal Business Name): JENNIFER VERMILION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE. BOX 278984
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2808
  • Fax: 585-275-3683
Mailing address:
  • Phone: 585-784-9277
  • Fax: 585-424-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number282973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: