Provider Demographics
NPI:1326018375
Name:QUEIROZ, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:QUEIROZ
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:PO BOX 8000
Mailing Address - Street 2:DEPT. 044
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1651
Practice Address - Country:US
Practice Address - Phone:315-787-5399
Practice Address - Fax:315-787-5391
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056533A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010199480OtherEXCELLUS - BC ROCHESTER
NY01982672Medicaid
H02517Medicare UPIN
NYRB1228Medicare PIN