Provider Demographics
NPI:1497985089
Name:UPHAM, ROBBYN O'CONNOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBBYN
Middle Name:O'CONNOR
Last Name:UPHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1724
Mailing Address - Country:US
Mailing Address - Phone:585-276-7640
Mailing Address - Fax:585-325-4255
Practice Address - Street 1:454 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1724
Practice Address - Country:US
Practice Address - Phone:585-276-7640
Practice Address - Fax:585-325-4255
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03948001Medicaid