Provider Demographics
NPI:1467446641
Name:FANARA, ROSS LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:LOUIS
Last Name:FANARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 W MAIN ST
Mailing Address - Street 2:PO BOX 422
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14021-0422
Mailing Address - Country:US
Mailing Address - Phone:585-343-8638
Mailing Address - Fax:585-344-0746
Practice Address - Street 1:4110 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1260
Practice Address - Country:US
Practice Address - Phone:484-343-8638
Practice Address - Fax:585-344-0746
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0022061213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
100078EQOtherPREF CARE
8042OtherROCHESTER
00020070501OtherUNIVERA
0055072OtherGHI
5508130OtherFIRST HEALTH
0055072OtherGHI
100078EQOtherPREF CARE