Provider Demographics
NPI:1073658704
Name:ROBERT H. OLIVER, M.D., PLLC
Entity Type:Organization
Organization Name:ROBERT H. OLIVER, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-342-2080
Mailing Address - Street 1:1295 PORTLAND AVE
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211704207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000917639004Medicaid
NY000917639004Medicaid
NYBA1026Medicare PIN