Healthcare Provider Details

I. General information

NPI: 1578236071
Provider Name (Legal Business Name): MARC-ANDRE HAMEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

50 CHESTNUT ST APT 802
ROCHESTER NY
14604-2322
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-5476
  • Fax:
Mailing address:
  • Phone: 581-994-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number308939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: