Provider Demographics
NPI:1063462356
Name:PACINO, JAMES R (RPA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:PACINO
Suffix:
Gender:M
Credentials:RPA
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-768-2620
Mailing Address - Fax:585-768-2694
Practice Address - Street 1:8745 LAKE ST RD
Practice Address - Street 2:STE 1
Practice Address - City:LEROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-768-2620
Practice Address - Fax:585-768-2694
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0037171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019003717OtherBCBS ROCHESTER
NY109529BFOtherPREFERRED CARE
NYP019003717OtherBLUE CHOICE
NY00026947702OtherUNIVERA
NY01954829Medicaid
NY000570054006OtherBCBC WNY
NY9512769OtherINDEPENDENT HEALTH
NY000570054006OtherBCBC WNY
NYP019003717OtherBCBS ROCHESTER