Provider Demographics
NPI:1346307212
Name:BADILLO DUMITRESCU, EMELIE (MD)
Entity Type:Individual
Prefix:
First Name:EMELIE
Middle Name:
Last Name:BADILLO DUMITRESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CANAL LANDING BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5107
Mailing Address - Country:US
Mailing Address - Phone:585-368-4050
Mailing Address - Fax:585-723-6705
Practice Address - Street 1:105 CANAL LANDING BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5107
Practice Address - Country:US
Practice Address - Phone:585-368-4050
Practice Address - Fax:585-723-6705
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250989207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV03061570Medicaid
NYP00775320OtherMEDICARE RAILROAD
NYJ400001164/70008AMedicare PIN
NYP00775320OtherMEDICARE RAILROAD