Basic Information
| Provider Information | |||||||||
| NPI: | 1528281599 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FARMINGTON FAMILY PRACTICE PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAUREL A DALLMEYER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CANANDAIGUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144241283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853933515 | ||||||||
| FaxNumber: | 5853933515 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CANANDAIGUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144241283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853933515 | ||||||||
| FaxNumber: | 5853933515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | DALLMEYER | ||||||||
| AuthorizedOfficialFirstName: | LAUREL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5853933515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2394701 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | F3330031 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 176102 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01388256 | 05 | NY | MEDICAID | 0186790370 | 01 | NY | BLUE CHOICE | OTHER |