Provider Demographics
NPI:1134146764
Name:FREDERICK R DOWNS MD
Entity Type:Organization
Organization Name:FREDERICK R DOWNS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-535-0051
Mailing Address - Street 1:4174 ROUTE 98
Mailing Address - Street 2:PO BOX 208
Mailing Address - City:NORTH JAVA
Mailing Address - State:NY
Mailing Address - Zip Code:14113
Mailing Address - Country:US
Mailing Address - Phone:585-535-0051
Mailing Address - Fax:585-535-0052
Practice Address - Street 1:4174 ROUTE 98
Practice Address - Street 2:
Practice Address - City:NORTH JAVA
Practice Address - State:NY
Practice Address - Zip Code:14113
Practice Address - Country:US
Practice Address - Phone:585-535-0051
Practice Address - Fax:585-535-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462280Medicaid
D71417Medicare UPIN
NY00462280Medicaid