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General NPI Number Information
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NPI Number | 1457884264
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Entity Type | Individual
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Provider Name | ELIZABETH ROSE WILLMAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVE BOX 668
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 990 SOUTH AVE STE 103
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City | ROCHESTER
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State | NY
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Zip | 14620-2740
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Country | US
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Telephone | 585-341-0101
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 309985
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 309985
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License Number State | NY
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