Healthcare Provider Details

I. General information

NPI: 1407883739
Provider Name (Legal Business Name): LOUIS SANDERS CONSTINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE # 647
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE # 647
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2171
  • Fax: 585-275-1531
Mailing address:
  • Phone: 585-275-2171
  • Fax: 585-275-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number148795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: