Provider Demographics
NPI:1184645095
Name:ATHYAL, VIDUSH PHILIP (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:VIDUSH
Middle Name:PHILIP
Last Name:ATHYAL
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Gender:M
Credentials:MD, MPH
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Other - Credentials:
Mailing Address - Street 1:777 CLINTON AVE S
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1448
Mailing Address - Country:US
Mailing Address - Phone:585-279-4720
Mailing Address - Fax:585-279-4725
Practice Address - Street 1:777 CLINTON AVE S
Practice Address - Street 2:SUITE 500
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1448
Practice Address - Country:US
Practice Address - Phone:585-279-4720
Practice Address - Fax:585-279-4725
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY245196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB5224Medicare PIN