MEDICARE: DR. CHAD B PRESTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	236083	NY

General Provider Information

NPI Number	:	1043293178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD B PRESTON M.D.

Provider Business Mailing Address
First Line	:	1700 HUDSON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5104
Country	:	US
Telephone Number	:	585-342-5665
Fax Number	:	585-342-2345

Provider Business Practice Location Address
First Line	:	1700 HUDSON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5104
Country	:	US
Telephone Number	:	585-342-5665
Fax Number	:	585-342-2345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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