Individual
ELIZABETH VARLAND MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4000
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
014911
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03457178
—
NY
01
—
12371645
CAQH
NY
Enumeration date
09/14/2011
Last updated
03/07/2023
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