Healthcare Provider Details

I. General information

NPI: 1841546827
Provider Name (Legal Business Name): RACHAEL WIEDEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL HOGANCAMP

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2706
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-6770
  • Fax: 585-424-6776
Mailing address:
  • Phone:
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: