Provider Demographics
NPI:1639194533
Name:NORTHWESTERN FINGER LAKES MEDICAL
Entity Type:Organization
Organization Name:NORTHWESTERN FINGER LAKES MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PINGREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-340-1480
Mailing Address - Street 1:1890 SWEETS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9141
Mailing Address - Country:US
Mailing Address - Phone:585-340-1480
Mailing Address - Fax:
Practice Address - Street 1:1890 SWEETS CORNERS RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9141
Practice Address - Country:US
Practice Address - Phone:585-340-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty