National Provider Identifier
Bennett Leroy Wilson, DO
Bennett Leroy Wilson, DO is listed in the NPPES registry with a primary specialty of Anatomic Pathology & Clinical Pathology Physician in Rochester, NY and a listed phone number of (585) 273-4580.
Profile Overview
- NPI
- 1891223616
- Provider Type
- Individual
- Primary Specialty
- Anatomic Pathology & Clinical Pathology Physician
- Enumeration Date
- May 24, 2017
- Last Updated
- July 21, 2022
Practice Location
- 601 Elmwood Ave Box 626
- Rochester, NY 14642-0001
Phone: (585) 273-4580
Specialties
- Anatomic Pathology & Clinical Pathology Physician (207ZP0102X)
Full Record
- NPI
- 1891223616
- Entity Type
- Individual
- Last Name
- Wilson
- First Name
- Bennett
- Middle Name
- Leroy
- Credential
- DO
- Mailing Street Address
- 601 Elmwood Ave Box 626
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14642-0001
- Mailing Country
- US
- Mailing Phone
- (585) 273-4580
- Mailing Fax
- (585) 276-1350
- Practice Street Address
- 601 Elmwood Ave Box 626
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14642-0001
- Practice Country
- US
- Practice Phone
- (585) 273-4580
- Practice Fax
- (585) 276-1350
- Enumeration Date
- May 24, 2017
- Last Updated
- July 21, 2022
- Sex
- Male
- Sole Proprietor
- Yes
- Taxonomy Group 1
- 193400000X Single Specialty Group
- Certification Date
- March 24, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Anatomic Pathology & Clinical Pathology Physician (207ZP0102X)
- Other Identifiers
- 0039 (NY)