Provider Demographics
NPI:1801822333
Name:MOMOT, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:MOMOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2212 PENFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1756
Practice Address - Country:US
Practice Address - Phone:585-598-8505
Practice Address - Fax:585-598-8122
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH32820Medicare UPIN
NYRA5919Medicare PIN