Healthcare Provider Details

I. General information

NPI: 1821034133
Provider Name (Legal Business Name): DANIEL B WOPPERER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

2263 S CLINTON AVE
ROCHESTER NY
14618-2623
US

V. Phone/Fax

Practice location:
  • Phone: 585-241-6400
  • Fax: 585-241-6505
Mailing address:
  • Phone: 585-241-6400
  • Fax: 585-241-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number153909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: