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General NPI Number Information
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NPI Number | 1376948893
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Entity Type | Organization
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Legal Business Name | BLOSSOM ROAD MEDICINE, PLLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 780 BLOSSOM RD
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City | ROCHESTER
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State | NY
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Zip | 14610-1914
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Country | US
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Telephone | 585-482-1141
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Fax | 585-270-4153
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Provider Business Mailing Address
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Address Line | 780 BLOSSOM RD
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City | ROCHESTER
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State | NY
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Zip | 14610-1914
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Country | US
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Telephone | 585-482-1141
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Fax | 585-270-4153
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MS. SANDRA BOEHLERT
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Credential | MD
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Telephone | 585-482-1141
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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 |
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License Number State |
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