Provider Demographics
NPI:1356671812
Name:TINKELMAN, DAVID MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:TINKELMAN
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 1:6 SWEDEN LN
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2516
Mailing Address - Country:US
Mailing Address - Phone:585-637-0060
Mailing Address - Fax:585-637-2911
Practice Address - Street 1:6 SWEDEN LN
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2516
Practice Address - Country:US
Practice Address - Phone:585-637-0060
Practice Address - Fax:585-637-2911
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133341208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00507488Medicaid
NYP010133341OtherBLUE CHOICE ROCHESTER
NY00507488Medicaid