Provider Demographics
NPI:1003819368
Name:OLIVER, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1295 PORTLAND AVE
Mailing Address - Street 2:STE. 24
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2731
Mailing Address - Country:US
Mailing Address - Phone:585-342-2080
Mailing Address - Fax:585-301-4037
Practice Address - Street 1:1295 PORTLAND AVE
Practice Address - Street 2:STE. 24
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2731
Practice Address - Country:US
Practice Address - Phone:585-342-2080
Practice Address - Fax:585-301-4037
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2015-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY211704-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01915420Medicaid
NY01915420Medicaid
NYG26876Medicare UPIN