Provider Demographics
NPI:1235129479
Name:JAMISON, MICHELE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:JAMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:90 ERIE CANAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4601
Mailing Address - Country:US
Mailing Address - Phone:585-225-5883
Mailing Address - Fax:585-225-8902
Practice Address - Street 1:90 ERIE CANAL DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4601
Practice Address - Country:US
Practice Address - Phone:585-225-5883
Practice Address - Fax:585-225-8902
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201772207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01821356Medicaid
P00065830OtherRR MEDICARE
NY01821356Medicaid
G65858Medicare UPIN