Basic Information
| Provider Information | |||||||||
| NPI: | 1154614386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWOLFE | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | DEPT OF NEPHROLOGY | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 601 ELMWOOD AVE | ||||||||
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| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146425324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852754517 | ||||||||
| FaxNumber: | 5854429201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LP02183 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 258574 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 288665 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.