Individual
DOUGLAS R FETKENHOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4901 LAC DE VILLE BLVD STE 250, ROCHESTER, NY 14618
(585) 275-3271
(585) 442-2949
Mailing address
601 ELMWOOD AVE BOX 664, ROCHESTER, NY 14642-0001
(585) 275-3271
(585) 442-2949
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
235170
NY
225400000X
Rehabilitation Practitioner
235170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02695178
—
NY
Enumeration date
12/14/2005
Last updated
07/05/2023
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