Provider Demographics
NPI:1578671301
Name:PEDULLA, ANGELO J (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:J
Last Name:PEDULLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 679-B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-341-6780
Mailing Address - Fax:585-341-8489
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:BOX 15
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-341-6780
Practice Address - Fax:585-341-8489
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-07-06
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Provider Licenses
StateLicense IDTaxonomies
NY250742207R00000X, 208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03248657Medicaid