MEDICARE: DR. MIRANDA HARRIS-GLOCKER 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	207V00000X	Obstetrics & Gynecology Physician	262345	NY

General Provider Information

NPI Number	:	1346450764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRANDA HARRIS-GLOCKER MD

Provider Business Mailing Address
First Line	:	101 CRITTENDEN BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4003
Country	:	US
Telephone Number	:	585-355-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 CULVER RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-7115
Country	:	US
Telephone Number	:	585-341-6732
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/09/2011

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