Individual
DR. TEODORO REYES MARIANO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 SPENCERPORT RD, ROCHESTER, NY 14606-4820
(585) 510-3883
Mailing address
800 SPENCERPORT RD, ROCHESTER, NY 14606-4820
(585) 510-3883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
129789
NY
207RC0000X
Cardiovascular Disease Physician
Primary
129789
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0524
BLUE CROSS BLUE SHIELD
NY
01
—
100768BJ
PREFERRED CARE PROVIDER
NY
01
—
224911
NYS WORKERS COMP
NY
01
—
2564331
AETNA HMO
NY
01
—
444111502
UNITED HEALTHCARE PPO
NY
01
—
5339337
AETNA PPO
NY
01
—
80121911498001
BCBS OF WESTERN NY
NY
01
—
MD1826
PREFERRED CARE PROVIDER
NY
01
—
MD2826
PREFERRED CARE CARDIOLOGY
NY
01
—
P010129789
BLUE CHOICE PROVIDER NO.
NY
Enumeration date
07/26/2006
Last updated
01/03/2024
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