Healthcare Provider Details

I. General information

NPI: 1629501499
Provider Name (Legal Business Name): ANNA-KAROLINE ISRAEL M.D., DR. MED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/22/2023
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 626
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 626
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-4580
  • Fax:
Mailing address:
  • Phone: 585-273-4135
  • Fax: 585-273-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number319429
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number319429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: