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NPI Code Detail

MEDICARE: ROBERT E STODDARD PA

MEDICARE: ROBERT E STODDARD PA
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
1363A00000XPhysician Assistant0007281NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P019000728OTHERNYBLUE CHOICE #
29513995OTHERNYIHA #
3109297DLOTHERNYPREFERRED CARE #

General Provider Information

NPI Number : 1750349072
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT E STODDARD PA
Provider Business Mailing Address
First Line : 800 CARTER STREET
Second Line :
City : ROCHESTER
State : NY
Zip : 14621
Country : US
Telephone Number : 585-336-4858
Fax Number : 585-336-4845
Provider Business Practice Location Address
First Line : 470 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14612-3057
Country : US
Telephone Number : 585-227-7600
Fax Number : 585-227-8322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 04/28/2009

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