Provider Demographics
NPI:1437187655
Name:EMERSON, DREW T (MD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:T
Last Name:EMERSON
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3509 THOMAS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9758
Practice Address - Country:US
Practice Address - Phone:585-346-3660
Practice Address - Fax:585-346-0574
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227933207Q00000X
NY227933-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDJ149OtherPREFERRED C ARE
NYP00683942OtherMEDICARE RAILROAD
NYP010227933OtherBLUE CHOICE
NYRA8005Medicare PIN
NYP00683942OtherMEDICARE RAILROAD