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General NPI Number Information
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NPI Number | 1548239296
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Entity Type | Organization
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Legal Business Name | UCVA MEDICAL, LLC
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 2365 S CLINTON AVE SUITE 100
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City | ROCHESTER
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State | NY
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Zip | 14618-2645
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Country | US
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Telephone | 585-442-5320
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Fax | 585-442-5526
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Provider Business Mailing Address
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Address Line | 2365 S CLINTON AVE SUITE 100
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City | ROCHESTER
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State | NY
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Zip | 14618-2645
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Country | US
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Telephone | 585-442-5320
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Fax | 585-442-5526
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MS. SARA J REID
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Credential |
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Telephone | 585-784-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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