Individual
STEPHEN E ETTINGHAUSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1415 PORTLAND AVE, SUITE 245, ROCHESTER, NY 14621-3038
(585) 922-4874
Mailing address
1415 PORTLAND AVE, SUITE 245, ROCHESTER, NY 14621-3038
(585) 922-4874
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
138462
NY
2086X0206X
Surgical Oncology Physician
Primary
138462
NY
Other
Enumeration date
07/03/2006
Last updated
08/06/2012
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