Healthcare Provider Details

I. General information

NPI: 1952412553
Provider Name (Legal Business Name): MICHAEL G MCGRATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LAKE AVE 3RD FLOOR
ROCHESTER NY
14608-1410
US

IV. Provider business mailing address

81 LAKE AVE 3RD FLOOR
ROCHESTER NY
14608-1410
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6900
  • Fax: 585-423-9523
Mailing address:
  • Phone: 585-368-6900
  • Fax: 585-423-9523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number160096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: