MEDICARE: DR. MATTHEW FUNDERBURK M.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	207R00000X	Internal Medicine Physician	230969	NY
2	207RC0000X	Cardiovascular Disease Physician	230969	NY

General Provider Information

NPI Number	:	1497765341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW FUNDERBURK M.D.

Provider Business Mailing Address
First Line	:	2365 S CLINTON AVE
Second Line	:	SUITE 100
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2663
Country	:	US
Telephone Number	:	585-442-5320
Fax Number	:	585-442-5526

Provider Business Practice Location Address
First Line	:	2365 S CLINTON AVE
Second Line	:	SUITE 100
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2663
Country	:	US
Telephone Number	:	585-442-5320
Fax Number	:	585-442-5526

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/26/2013

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