Provider Demographics
NPI:1881652907
Name:OSTRANDER, ROBERT JOHN (M D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:OSTRANDER
Suffix:
Gender:M
Credentials:M D
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:585-554-3119
Mailing Address - Fax:585-554-3323
Practice Address - Street 1:213 STATE ROUTE 245
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9604
Practice Address - Country:US
Practice Address - Phone:585-554-3119
Practice Address - Fax:585-554-3323
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160360208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948072Medicaid
NYMD1625OtherPREFFERED CARE
NY1234OtherBC/BS
NYB72292Medicare UPIN
NY13053BMedicare ID - Type Unspecified