Healthcare Provider Details

I. General information

NPI: 1194725788
Provider Name (Legal Business Name): BRIAN D ADCOCK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 SENATOR KEATING BLVD BUILDING E STE 330
ROCHESTER NY
14618-2775
US

IV. Provider business mailing address

PO BOX 8000 DEPT. 441
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 585-232-2980
  • Fax: 585-232-6522
Mailing address:
  • Phone: 716-844-5600
  • Fax: 716-844-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003405-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: