=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851320204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHARINE D DEISS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 07/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 S POINTE LNDG STE 210
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14606-3481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-723-3330
-----------------------------------------------------
Fax | 585-723-0555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 S POINTE LNDG STE 210
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14606-3481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-723-3330
-----------------------------------------------------
Fax | 585-723-0555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 236626
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 236626
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------