MEDICARE: MARIA ELENA BANGHART 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	208000000X	Pediatrics Physician	196550	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	:	1588625172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELENA BANGHART M.D.

Provider Business Mailing Address
First Line	:	222 ALEXANDER ST
Second Line	:	SUITE 4200
City	:	ROCHESTER
State	:	NY
Zip	:	14607-4039
Country	:	US
Telephone Number	:	585-922-8210
Fax Number	:	585-922-8260

Provider Business Practice Location Address
First Line	:	222 ALEXANDER ST
Second Line	:	SUITE 4200
City	:	ROCHESTER
State	:	NY
Zip	:	14607-4039
Country	:	US
Telephone Number	:	585-922-8210
Fax Number	:	585-922-8260

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	04/26/2021

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