Healthcare Provider Details

I. General information

NPI: 1740644145
Provider Name (Legal Business Name): VICTOR KUCHEROV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 656
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMT210872
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD210002642
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number328552
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: