Provider Demographics
NPI:1093742868
Name:NAZAR, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:NAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 LAKE AVENUE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612
Mailing Address - Country:US
Mailing Address - Phone:585-254-1850
Mailing Address - Fax:585-254-0549
Practice Address - Street 1:2260 LAKE AVENUE
Practice Address - Street 2:SUITE 1000
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612
Practice Address - Country:US
Practice Address - Phone:585-254-1850
Practice Address - Fax:585-254-0549
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA0104- GROUP BA0017Medicare PIN
NYBB6227- GROUP 70008AMedicare PIN
1549385WCFPOtherWORKERS COMP
NYBB6227- GROUP 70008AMedicare PIN