Individual
JESSICA LE SEVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
229 SUMMIT ST, SUITE 7, BATAVIA, NY 14020-1645
(585) 344-4811
(585) 344-4812
Mailing address
601 ELMWOOD AVE, BOX 697, ROCHESTER, NY 14642-0001
(585) 275-7546
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
224394
NY
207N00000X
Dermatology Physician
7901
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025998201
UNIVERA
NY
01
—
000919915002
COMMUNITY BLUE
NY
01
—
0311421
INDEPENDENT HEALTH
NY
01
—
109598
PREFERRED CARE
NY
01
—
2200273
GHI
NY
01
—
7851362
AETNA INSURANCE
NY
01
—
G0183268190
BLUE CHOICE GROUP NUMBER
NY
01
—
P010224394
BLUE CHOICE
NY
Enumeration date
11/17/2006
Last updated
03/17/2011
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