Basic Information
| Provider Information | |||||||||
| NPI: | 1588610760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARY M PARKES ASTHMA & PULMONARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX MED | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852731741 | ||||||||
| FaxNumber: | 5852762140 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 RED CREEK DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146234273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854860147 | ||||||||
| FaxNumber: | 5854860673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | HETTERICH | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR OF FINANCE URMFG | ||||||||
| AuthorizedOfficialTelephone: | 5857564008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.