Provider Demographics
NPI:1831134378
Name:CULOTTA, MARY (RPA C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CULOTTA
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:TCU UNIT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7135
Mailing Address - Fax:585-723-7118
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:TCU UNIT
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7135
Practice Address - Fax:585-723-7118
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000288363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R53464Medicare UPIN
NYPA0536 / BA0017 GRUPMedicare PIN