MEDICARE: MARIE AYDELOTTE 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	175071-1	NY
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	175071-1	NY

General Provider Information

NPI Number	:	1558364851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE AYDELOTTE M.D.

Provider Business Mailing Address
First Line	:	2021 WINTON RD S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3957
Country	:	US
Telephone Number	:	585-784-6400
Fax Number	:	585-341-2370

Provider Business Practice Location Address
First Line	:	2021 WINTON RD S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3957
Country	:	US
Telephone Number	:	585-784-6400
Fax Number	:	585-341-2370

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/12/2016

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