MEDICARE: GREATER ROCHESTER INTERNAL MEDICINE PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1649300245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER ROCHESTER INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	1401 STONE RD STE 201
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-1537
Country	:	US
Telephone Number	:	585-865-1110
Fax Number	:	585-865-1124

Provider Business Practice Location Address
First Line	:	1401 STONE RD STE 201
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-1537
Country	:	US
Telephone Number	:	585-865-1110
Fax Number	:	585-865-1124

Authorized Official
Title or Position	:	PRINCIPLE
Name	:	DR. ANTHONY RAGUSA
Credential	:	MD
Telephone Number	:	585-865-1110

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/02/2009

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