MEDICARE: LAURA BETH FORNAROLA M.D./PH.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	207L00000X	Anesthesiology Physician	30421201	NY

General Provider Information

NPI Number	:	1194179754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BETH FORNAROLA M.D./PH.D

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE BOX 604
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-1385
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-4122
Country	:	US
Telephone Number	:	585-275-2141
Fax Number	:

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

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	11/22/2023

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