Healthcare Provider Details

I. General information

NPI: 1053040691
Provider Name (Legal Business Name): MATTHEW LAWRENCE KUHL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 07/17/2023
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 SAWGRASS DR FL 2
ROCHESTER NY
14620-4648
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 656
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2838
  • Fax:
Mailing address:
  • Phone: 585-275-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number28648
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number028648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: