Provider Demographics
NPI:1780181909
Name:GERMAN, DERRICK ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:ALEXIS
Last Name:GERMAN
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 1:1835 FAIRPORT NINE MILE POINT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1903
Mailing Address - Country:US
Mailing Address - Phone:585-758-0777
Mailing Address - Fax:585-388-9079
Practice Address - Street 1:1835 FAIRPORT NINE MILE POINT RD STE 100
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1903
Practice Address - Country:US
Practice Address - Phone:585-758-0777
Practice Address - Fax:585-388-9079
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307278207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant