=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932340932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOCHO MENSAH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2009
-----------------------------------------------------
Last Update Date | 11/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 LONG POND RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626-4164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-922-5067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 SYCAMORE LN
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701-6382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-352-9500
-----------------------------------------------------
Fax | 801-352-9502
-----------------------------------------------------
=====================================================
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 | 0101244745
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 311766
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 311766
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------