Provider Demographics
NPI:1629272810
Name:KORNI, ROOPA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOPA
Middle Name:M
Last Name:KORNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2450 W RIDGE RD
Mailing Address - Street 2:STE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3037
Mailing Address - Country:US
Mailing Address - Phone:585-413-3520
Mailing Address - Fax:585-360-4181
Practice Address - Street 1:2450 W RIDGE RD
Practice Address - Street 2:STE 202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3037
Practice Address - Country:US
Practice Address - Phone:585-413-3520
Practice Address - Fax:585-360-4181
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2016-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY253455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1265776181OtherMEDICAIRE NPI
NY03127759Medicaid