MEDICARE: MARY A DINNAN PA

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	363A00000X	Physician Assistant	000557	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194792960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A DINNAN PA

Provider Business Mailing Address
First Line	:	1338 E RIDGE RD
Second Line	:	SUITE 101
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2018
Country	:	US
Telephone Number	:	585-922-7140
Fax Number	:	585-336-9029

Provider Business Practice Location Address
First Line	:	1338 E RIDGE RD
Second Line	:	SUITE 101
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2018
Country	:	US
Telephone Number	:	585-922-7140
Fax Number	:	585-336-9029

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	08/06/2009

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Directions to “ MARY A DINNAN PA” Practice Location

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