Provider Demographics
NPI:1467416768
Name:BOBROW, MICHAEL BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:BOBROW
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 1:120 ERIE CANAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4609
Mailing Address - Country:US
Mailing Address - Phone:585-719-9600
Mailing Address - Fax:585-719-9872
Practice Address - Street 1:120 ERIE CANAL DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4609
Practice Address - Country:US
Practice Address - Phone:585-719-9600
Practice Address - Fax:585-719-9872
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210151207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H15255Medicare UPIN
CC0467Medicare ID - Type Unspecified