Basic Information
| Provider Information | |||||||||
| NPI: | 1699063941 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EDRISSIAN | ||||||||
| FirstName: | MOHAMMADOMID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859221469 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | RHEUMATOLOGY | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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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 | 207RR0500X | 40781 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 208M00000X | 40781 | IA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD443871 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RR0500X | 280630 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.