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General NPI Number Information
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NPI Number | 1760724694
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Entity Type | Individual
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Provider Name | DESPINA N ISIHOS D.O
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Gender | Female
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVE BOX MED
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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 | 585-275-4912
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Fax | 585-276-2144
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVE BOX MED
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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 | 585-275-4912
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Fax | 585-276-2144
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 000000000000000000
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 282911
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License Number State | NY
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