MEDICARE: MARK PEREIRA 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	207RG0100X	Gastroenterology Physician	138165	NY

General Provider Information

NPI Number	:	1942277017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PEREIRA MD

Provider Business Mailing Address
First Line	:	2440 RIDGEWAY AVE
Second Line	:	SUITE #100
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4145
Country	:	US
Telephone Number	:	585-720-1550
Fax Number	:	585-720-1553

Provider Business Practice Location Address
First Line	:	2440 RIDGEWAY AVE
Second Line	:	SUITE #100
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4145
Country	:	US
Telephone Number	:	585-720-1550
Fax Number	:	585-720-1553

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	03/21/2013

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