=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710059324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES T CAVALLARO DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 MONROE AVE STE 325
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-727-3333
-----------------------------------------------------
Fax | 585-456-1944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 MONROE PKWY
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-727-3333
-----------------------------------------------------
Fax | 585-456-1944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 180124
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------