Healthcare Provider Details

I. General information

NPI: 1811900939
Provider Name (Legal Business Name): RONALD BOSSERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 661
ROCHESTER NY
14642-8410
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 661
ROCHESTER NY
14642-8410
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1000
  • Fax: 585-276-1985
Mailing address:
  • Phone: 585-275-1000
  • Fax: 585-276-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number264592
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number264592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: