Provider Demographics
NPI:1760595854
Name:RAPOPORT, RAM WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:WESLEY
Last Name:RAPOPORT
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 1:73 TOBEY CT
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1859
Mailing Address - Country:US
Mailing Address - Phone:585-383-0449
Mailing Address - Fax:585-621-1456
Practice Address - Street 1:81 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1410
Practice Address - Country:US
Practice Address - Phone:585-368-6900
Practice Address - Fax:585-368-6955
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0968992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY096899-0B-CPNOtherWORKER'S COMPENSATION
NY5367344OtherAETNA
NYB72039Medicare UPIN
NYDD1783Medicare ID - Type Unspecified70008A GROUP
NYRA6798Medicare ID - Type UnspecifiedBA0017 GROUP
NY100540EUOtherPREFERRED CARE