Individual
MISS CAROL DIANE FAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
1000 SOUTH AVE, ROCHESTER, NY 14620-2733
(585) 341-6880
Mailing address
601 ELMWOOD AVE, BOX 655, ROCHESTER, NY 14642-8655
(585) 341-6880
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
06/18/2009
Last updated
09/26/2011
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