MEDICARE: DR. JAN ANDRE GRAUMAN NEANDER MD

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	208D00000X	General Practice Physician	290607	NY

General Provider Information

NPI Number	:	1912422122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN ANDRE GRAUMAN NEANDER MD

Provider Business Mailing Address
First Line	:	57 WESTMORELAND DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 WESTMORELAND DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4533
Country	:	US
Telephone Number	:	204-619-2411
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	08/08/2017

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