MEDICARE: ANJA I BOTTLER 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	207RI0200X	Infectious Disease Physician	254013	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	:	1396712113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJA I BOTTLER MD

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-922-0553
Fax Number	:	585-922-0496

Provider Business Practice Location Address
First Line	:	55 GENESEE ST BK BUILDING, 1ST FLOOR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14611
Country	:	US
Telephone Number	:	585-368-3506
Fax Number	:	585-368-3163

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	04/23/2021

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