Provider Demographics
NPI:1700816139
Name:CHRISTIDIS, ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:CHRISTIDIS
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 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 480
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-865-8210
Mailing Address - Fax:585-865-7597
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-865-8210
Practice Address - Fax:585-865-7597
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01872260Medicaid
2111037WIMOtherWORKERS COMP
NY01872260Medicaid
NYJ400204880/GRP70008AMedicare PIN
G78710Medicare UPIN