Healthcare Provider Details

I. General information

NPI: 1942488309
Provider Name (Legal Business Name): ROCHESTER VASCULAR MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 BUFFALO RD
ROCHESTER NY
14624-1182
US

IV. Provider business mailing address

3525 BUFFALO RD
ROCHESTER NY
14624-1182
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-2000
  • Fax: 585-594-2223
Mailing address:
  • Phone: 585-594-2000
  • Fax: 585-594-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MALUR BALAJI
Title or Position: OWNER
Credential: MD
Phone: 585-594-2000