Healthcare Provider Details

I. General information

NPI: 1023533064
Provider Name (Legal Business Name): FERNANDO CAUMONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CULVER RD STE 100
ROCHESTER NY
14609
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-336-5320
  • Fax: 585-336-9114
Mailing address:
  • Phone: 585-336-5320
  • Fax: 585-336-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number299049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: