Basic Information
| Provider Information | |||||||||
| NPI: | 1538375910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENNA | ||||||||
| FirstName: | MARGO | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BENOIT | ||||||||
| OtherFirstName: | MARGO | ||||||||
| OtherMiddleName: | M. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF OTOLARYNGOLOGY | ||||||||
| Address2: | 125 LATTIMORE RD. | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | 5857581293 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPARTMENT OF OTOLARYNGOLOGY | ||||||||
| Address2: | 125 LATTIMORE RD. | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | 5857581293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 218050 | MA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 242624 | MA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 262243 | NY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.