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General NPI Number Information
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NPI Number | 1942543269
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Entity Type | Individual
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Provider Name | DMITRIY MIGDALOVICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 1000 SOUTH AVE # 58
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City | ROCHESTER
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State | NY
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Zip | 14620-2733
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Country | US
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Telephone | 585-341-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 SOUTH AVE # 58
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City | ROCHESTER
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State | NY
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Zip | 14620-2733
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Country | US
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Telephone |
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 282359
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 282359
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License Number State | NY
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