MEDICARE: DERMATOLOGY ASSOCIATES OF ROCHESTER, PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1174632285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY ASSOCIATES OF ROCHESTER, PC

Provider Business Mailing Address
First Line	:	100 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1507
Country	:	US
Telephone Number	:	585-272-0700
Fax Number	:	585-697-0822

Provider Business Practice Location Address
First Line	:	100 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1507
Country	:	US
Telephone Number	:	585-272-0700
Fax Number	:	585-697-0822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT W LOSS JR.
Credential	:	M.D.
Telephone Number	:	585-272-0700

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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