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BERTHOLLET M BAVIBIDILA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1425 PORTLAND AVE, WILSON BLDG, ROCHESTER, NY 14621
(585) 338-1400
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
203530
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00027212601
UNIVERA
NY
05
00355266
NY
01
0414023
IHA
NY
01
051006000001
FIDELIS
NY
01
101660BJ
PREFERRED CARE
NY
01
110242022
MEDICARE RAILROAD
NY
01
11121577
CAQH
NY
01
1245
SIDNEY HILLMAN
NY
01
P010203530
BLUE CHOICE
NY
Enumeration date
05/02/2006
Last updated
08/19/2022
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