Healthcare Provider Details

I. General information

NPI: 1033348891
Provider Name (Legal Business Name): PETER ANTHONY PRIETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-4009
US

IV. Provider business mailing address

UNIVERISTY OF ROCHESTER MEDICAL CENTER, DEPT OF SURGERY 601 ELMWOOD AVE, BOX SURG
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1611
  • Fax: 585-273-1252
Mailing address:
  • Phone: 585-276-3332
  • Fax: 585-273-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberQ0154
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number287527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: