National Provider Identifier
Internal Medicine At Lakeside
Internal Medicine At Lakeside is listed in the NPPES registry with a primary specialty of Internal Medicine Physician in Brockport, NY and a listed phone number of (585) 395-6095.
Source: public NPPES record, last updated April 06, 2010. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1083939722
- Provider Type
- Organization
- Primary Specialty
- Internal Medicine Physician
- Enumeration Date
- April 06, 2010
- Last Updated
- April 06, 2010
Practice Location
- 156 West Ave
- Suite 106
- Brockport, NY 14420-1229
Phone: (585) 395-6095
Mailing Address
- 156 West Avenue
- Suite 106
- Brockport, NY 14420
Authorized Official
- Name
- Mrs. Nancy M Wilson
- Title
- Physician Practices
- Phone
- (585) 395-6095
Specialties
- Internal Medicine Physician (207R00000X)
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Full Record
- NPI
- 1083939722
- Entity Type
- Organization
- Organization Name
- Internal Medicine At Lakeside
- Mailing Street Address
- 156 West Avenue
- Mailing Address Line 2
- Suite 106
- Mailing City
- Brockport
- Mailing State
- NY
- Mailing ZIP Code
- 14420
- Mailing Country
- US
- Mailing Phone
- (585) 395-6095
- Mailing Fax
- (585) 395-6084
- Practice Street Address
- 156 West Ave
- Practice Address Line 2
- Suite 106
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-1229
- Practice Country
- US
- Practice Phone
- (585) 395-6095
- Practice Fax
- (585) 395-6084
- Enumeration Date
- April 06, 2010
- Last Updated
- April 06, 2010
- Authorized Official Last Name
- Wilson
- Authorized Official First Name
- Nancy
- Authorized Official Middle Name
- M
- Authorized Official Title
- Physician Practices
- Authorized Official Phone
- (585) 395-6095
- Organization Subpart
- Yes
- Parent Organization Name
- LAKESIDE MEMORIAL HOSPITAL
- Authorized Official Name Prefix Text
- Mrs.
- Taxonomy Group 1
- 193400000X Single Specialty Group
- Taxonomies
- Internal Medicine Physician (207R00000X)