Provider Demographics
NPI:1518279827
Name:FOX, KELITA L (MD)
Entity Type:Individual
Prefix:
First Name:KELITA
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELITA
Other - Middle Name:L
Other - Last Name:SINCLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-1361
Mailing Address - Country:US
Mailing Address - Phone:585-368-4500
Mailing Address - Fax:585-436-6047
Practice Address - Street 1:158 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-1361
Practice Address - Country:US
Practice Address - Phone:585-368-4500
Practice Address - Fax:585-436-6047
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301501395207Q00000X
NY269938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03687625Medicaid
NY03687625Medicaid
NYJ400339435-GRPBA0017Medicare PIN