MEDICARE: MR. WARREN ELLIOTT II

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	347C00000X	Private Vehicle

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	:	1609590108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WARREN ELLIOTT II

Provider Business Mailing Address
First Line	:	34 IRONDEQUOIT ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14605-1523
Country	:	US
Telephone Number	:	585-481-5728
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 AUSTIN ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-1708
Country	:	US
Telephone Number	:	585-469-7568
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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