National Provider Identifier
Lakeside Hospital Internal Medicine Group
Lakeside Hospital Internal Medicine Group 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 July 14, 2009. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1962555854
- Provider Type
- Organization
- Primary Specialty
- Internal Medicine Physician
- Enumeration Date
- January 22, 2007
- Last Updated
- July 14, 2009
Practice Location
- 156 West Ave
- Brockport, NY 14420-1229
Phone: (585) 395-6095
Authorized Official
- Name
- Rajendra Mehta
- Title
- Partner
- Credentials
- M.D.
- Phone
- (585) 637-9196
Specialties
- Internal Medicine Physician (207R00000X)
Browse Similar Providers
See more providers in the Internal Medicine classification in Brockport, NY.
Full Record
- NPI
- 1962555854
- Entity Type
- Organization
- Organization Name
- Lakeside Hospital Internal Medicine Group
- Mailing Street Address
- 156 West Ave
- Mailing City
- Brockport
- Mailing State
- NY
- Mailing ZIP Code
- 14420-1229
- Mailing Country
- US
- Mailing Phone
- (585) 395-6095
- Mailing Fax
- (585) 395-6036
- Practice Street Address
- 156 West Ave
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-1229
- Practice Country
- US
- Practice Phone
- (585) 395-6095
- Practice Fax
- (585) 395-6036
- Enumeration Date
- January 22, 2007
- Last Updated
- July 14, 2009
- Authorized Official Last Name
- Mehta
- Authorized Official First Name
- Rajendra
- Authorized Official Title
- Partner
- Authorized Official Phone
- (585) 637-9196
- Organization Subpart
- No
- Authorized Official Credential Text
- M.D.
- Taxonomy Group 1
- 193400000X Multiple Single Specialty Group
- Taxonomies
- Internal Medicine Physician (207R00000X)
- Other Identifiers
- G0181141590 (NY, Blue Cross), 02198570 (NY), MG150 (NY, Preferred Care)