Provider Demographics
NPI:1164433249
Name:THIELE, RALF (MD)
Entity Type:Individual
Prefix:
First Name:RALF
Middle Name:
Last Name:THIELE
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX MED
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-6275
Mailing Address - Fax:585-276-2140
Practice Address - Street 1:400 RED CREEK DR
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-486-0901
Practice Address - Fax:585-340-5399
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07649400207R00000X, 207RR0500X
NY241557207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB1107Medicare PIN