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General NPI Number Information
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NPI Number | 1194794073
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Entity Type | Individual
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Provider Name | GRAMA SITHARAM JAGADISH M.D
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 1401 STONE RD SUITE 103
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City | ROCHESTER
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State | NY
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Zip | 14615-1537
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Country | US
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Telephone | 585-663-3720
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Fax | 585-663-8391
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Provider Business Mailing Address
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Address Line | 1401 STONE RD SUITE 103
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City | ROCHESTER
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State | NY
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Zip | 14615-1537
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Country | US
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Telephone | 585-663-3720
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Fax | 585-663-8391
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 163052
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License Number State | NY
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