MEDICARE: SOPHIA E RUSS MD

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	207R00000X	Internal Medicine Physician	311935	NY
2	208M00000X	Hospitalist Physician	311935	NY

General Provider Information

NPI Number	:	1245720093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA E RUSS MD

Provider Business Mailing Address
First Line	:	1000 SOUTH AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE BOX MED
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-2874
Fax Number	:

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

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	01/15/2026

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