Provider Demographics
NPI:1780671511
Name:PETTEE, ALLEN DANFORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DANFORTH
Last Name:PETTEE
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 1:2101 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5643
Mailing Address - Country:US
Mailing Address - Phone:585-546-7266
Mailing Address - Fax:585-232-5158
Practice Address - Street 1:2101 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5643
Practice Address - Country:US
Practice Address - Phone:585-546-7266
Practice Address - Fax:585-232-5158
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1996852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01642644Medicaid
NY01642644Medicaid
NY11990FMedicare ID - Type Unspecified