Provider Demographics
NPI:1790914026
Name:ALCANTARA CONTRERAS, JOSE ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:ALCANTARA CONTRERAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:ANGEL
Other - Last Name:ALCANTARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:RGH DEPT. OF MEDICINE, 5TH FLOOR
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-5067
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:RGH DEPT. OF MEDICINE, 5TH FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004054208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03478017Medicaid
NYJ400074113Medicare PIN
NY10712AMedicare PIN
NYJ400074115Medicare PIN
NY70005AMedicare PIN