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NPI Code Detail

MEDICARE: ALEXI BULLOCH MD

MEDICARE: ALEXI BULLOCH 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine Physician306521NY
3208000000XPediatrics Physician306521NY

General Provider Information

NPI Number : 1538515291
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXI BULLOCH MD
Provider Business Mailing Address
First Line : 108 GARFORD RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14622-1801
Country : US
Telephone Number : 512-734-0931
Fax Number :
Provider Business Practice Location Address
First Line : 350 PARRISH ST
Second Line :
City : CANANDAIGUA
State : NY
Zip : 14424-1793
Country : US
Telephone Number : 585-396-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2016
Last Update Date : 07/03/2023

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