Individual
DR. THECKEDATH MATHEW
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1445 PORTLAND AVENUE, SUITE 208, ROCHESTER, NY 14621
(585) 338-2322
Mailing address
21 RUNNYMEDE COURT, ROCHESTER, NE 14618
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
137136
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00719080
—
NY
Enumeration date
06/15/2006
Last updated
07/08/2007
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