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NPI Code Detail

MEDICARE: UCVA MEDICAL, LLC

MEDICARE: UCVA MEDICAL, LLC
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
1207RC0000XCardiovascular Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548239296
Entity Type Code : Organization
Provider Name (Legal Business Name) : UCVA MEDICAL, LLC
Provider Business Mailing Address
First Line : 2365 S CLINTON AVE
Second Line : SUITE 100
City : ROCHESTER
State : NY
Zip : 14618-2645
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 : 14618-2645
Country : US
Telephone Number : 585-442-5320
Fax Number : 585-442-5526
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : MS. SARA J REID
Credential :
Telephone Number : 585-784-8141
Provider Enumeration Date : 03/15/2006
Last Update Date : 03/22/2013

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Directions to “UCVA MEDICAL, LLC ” Practice Location

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