Provider Demographics
NPI:1851320204
Name:DEISS, KATHARINE D (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:D
Last Name:DEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S POINTE LNDG
Mailing Address - Street 2:STE 210
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3481
Mailing Address - Country:US
Mailing Address - Phone:585-723-3330
Mailing Address - Fax:585-723-0555
Practice Address - Street 1:10 S POINTE LNDG
Practice Address - Street 2:STE 210
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3481
Practice Address - Country:US
Practice Address - Phone:585-723-3330
Practice Address - Fax:585-723-0555
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236626208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02359346Medicaid
NYRB2829Medicare PIN