Provider Demographics
NPI:1619945599
Name:MCGRODY, KEVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:MCGRODY
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 1:140 CANAL VIEW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2808
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-242-9663
Practice Address - Street 1:140 CANAL VIEW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2808
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-242-9663
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218936207RC0001X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000927831002OtherHEALTH NOW LINDEN OAKS
161150309OtherTRICARE CHAMPUS
MDJ014OtherPREFERRED CARE
NY02645325Medicaid
000927831001OtherCOMM. BLUE/BCBSWNY
2197576OtherGHI
380144OtherMVP
7166670OtherAETNA
PO10218936OtherEXCELLUS
6890OtherBCBS
PO0228312OtherRAILROAD MEDICARE
000927831001OtherHEALTH NOW POB
00002532476OtherUNITED HEALTHCARE
301139OtherWELLCARE
PO10218936OtherGRIPA
RC60218936OtherRCIPA
000927831001OtherHEALTH NOW POB
000927831001OtherHEALTH NOW POB