| Lattimore Primary Care Medicine, Pllc | |
|
560 White Spruce Blvd Rochester NY 14623-1613 | |
| (585) 271-5250 | |
| (585) 271-0129 |
| Full Name | Lattimore Primary Care Medicine, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 560 White Spruce Blvd, Rochester, New York |
| Authorized Official Name and Position | Russell P Maggio (OWNER) |
| Authorized Official Contact | 5852715250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lattimore Primary Care Medicine, Pllc 560 White Spruce Blvd Rochester NY 14623-1613 Ph: (585) 271-5250 | Lattimore Primary Care Medicine, Pllc 560 White Spruce Blvd Rochester NY 14623-1613 Ph: (585) 271-5250 |
| NPI Number | 1730421272 |
|---|---|
| Provider Enumeration Date | 03/22/2013 |
| Last Update Date | 03/22/2013 |
| Medicare PECOS PAC ID | 6800020793 |
|---|---|
| Medicare Enrollment ID | O20131008001542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730421272 | NPI | - | NPPES |
| 1392 | Other | NY | EXCELLUS |
| MD198C | Other | NY | MVP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 161925 (New York) | Primary |
| Provider Name | Russell P Maggio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518932441 PECOS PAC ID: 8921022641 Enrollment ID: I20060316000443 |
| Provider Name | Hillary A Mcconnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316993900 PECOS PAC ID: 4789691718 Enrollment ID: I20060317000092 |
| Provider Name | Maryana Konyk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891731824 PECOS PAC ID: 5092819987 Enrollment ID: I20070403000085 |
| Provider Name | Lisa M Kessel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154550523 PECOS PAC ID: 2860533171 Enrollment ID: I20100108000622 |
| Provider Name | Kelly Jo Gursslin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972916799 PECOS PAC ID: 6406175231 Enrollment ID: I20150429001407 |
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