MEDICARE: DR. VIDUSH PHILIP ATHYAL MD, MPH

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	207Q00000X	Family Medicine Physician	245196	NY

General Provider Information

NPI Number	:	1184645095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDUSH PHILIP ATHYAL MD, MPH

Provider Business Mailing Address
First Line	:	777 CLINTON AVE S
Second Line	:	SUITE 500
City	:	ROCHESTER
State	:	NY
Zip	:	14620-1448
Country	:	US
Telephone Number	:	585-279-4720
Fax Number	:	585-279-4725

Provider Business Practice Location Address
First Line	:	777 CLINTON AVE S
Second Line	:	SUITE 500
City	:	ROCHESTER
State	:	NY
Zip	:	14620-1448
Country	:	US
Telephone Number	:	585-279-4720
Fax Number	:	585-279-4725

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	12/03/2021

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