Provider Demographics
NPI:1508898693
Name:BROTHERS, MARY ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:PARK RIDGE LIVING CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7205
Mailing Address - Fax:585-723-7118
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:PARK RIDGE LIVING CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7205
Practice Address - Fax:585-723-7118
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002522363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0497 - GRP: BA0017Medicare PIN
NYP10642Medicare UPIN
NYCC1275 - GRP 70008AMedicare PIN