Provider Demographics
NPI:1841235314
Name:LAMARQUE, IVAN (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:LAMARQUE
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-723-7070
Mailing Address - Fax:585-723-7045
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7070
Practice Address - Fax:585-723-7045
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141868207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141868-OW CEMOtherWORKER'S COMPENSATION
NY01050311Medicaid
NYL70018-GRP:70008AMedicare PIN
E15858Medicare UPIN
NY01050311Medicaid