MEDICARE: DR. MEREDITH EMDEN GANSNER 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	2084P0804X	Child & Adolescent Psychiatry Physician	266563	MA
2	2084P0804X	Child & Adolescent Psychiatry Physician	337157	NY

General Provider Information

NPI Number	:	1659613008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDITH EMDEN GANSNER M.D.

Provider Business Mailing Address
First Line	:	300 CRITTENDEN BLVD BOX PSYCH
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CRITTENDEN BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-5724
Country	:	US
Telephone Number	:	585-275-5300
Fax Number	:

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

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	07/14/2025

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