MEDICARE: STELLA O KING 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	207Q00000X	Family Medicine Physician	257810	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	:	1528032646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA O KING MD

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE, BOX PSYCH
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0002
Country	:	US
Telephone Number	:	585-279-4999
Fax Number	:	585-473-5152

Provider Business Practice Location Address
First Line	:	2613 WEST HENRIETTA RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2327
Country	:	US
Telephone Number	:	585-279-4999
Fax Number	:	585-473-5152

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	05/15/2023

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Directions to “ STELLA O KING MD” Practice Location

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