Healthcare Provider Details

I. General information

NPI: 1417033796
Provider Name (Legal Business Name): MD ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RED CREEK DR
ROCHESTER NY
14623-4272
US

IV. Provider business mailing address

125 RED CREEK DR
ROCHESTER NY
14623-4272
US

V. Phone/Fax

Practice location:
  • Phone: 585-486-0600
  • Fax: 585-486-0649
Mailing address:
  • Phone: 585-486-0600
  • Fax: 585-486-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN DOMBROWSKI
Title or Position: DOCTOR
Credential: MD
Phone: 585-486-0600