Individual
MARY PUDUSSERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(585) 275-4751
Mailing address
601 ELMWOOD AVE, BOX 679B, ROCHESTER, NY 14642-0001
(585) 275-2475
(585) 473-0477
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
157278
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026569401
UNIVERA
NY
01
—
000913019003
BC/BS OF WESTERN NY
NY
05
—
01009374
—
NY
01
—
5137351
AETNA
NY
01
—
MDH648
PREFERRED CARE
NY
01
—
P00061001
MEDICARE RAILROAD
NY
01
—
P010157278
BLUE SHIELD
NY
Enumeration date
06/09/2006
Last updated
07/05/2023
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