Provider Demographics
NPI:1619912847
Name:AQUAVELLA, JAMES V (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:AQUAVELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 659
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3937
Mailing Address - Fax:585-276-0292
Practice Address - Street 1:601 ELMWOOD AVE BOX 659
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-3937
Practice Address - Fax:585-276-0292
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY84662207WX0120X
NY084662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00465816Medicaid
NY00879314Medicaid
NYU67583Medicare UPIN
NY00879314Medicaid
NYAA0106Medicare PIN
NYB72455Medicare UPIN
NY00465816Medicaid
NY0997920001Medicare NSC