Provider Demographics
NPI:1922171610
Name:SEVERSON, JESSICA LE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LE
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 697
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7546
Mailing Address - Fax:
Practice Address - Street 1:229 SUMMIT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-344-4811
Practice Address - Fax:585-344-4812
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-03-17
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Provider Licenses
StateLicense IDTaxonomies
NY224394207N00000X
ND7901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000919915002OtherCOMMUNITY BLUE
NY00025998201OtherUNIVERA
NY7851362OtherAETNA INSURANCE
NYG0183268190OtherBLUE CHOICE GROUP NUMBER
NYP010224394OtherBLUE CHOICE
NY2200273OtherGHI
NY109598OtherPREFERRED CARE
NY000919915002OtherBLUE CROSS OF WNY
NY0311421OtherINDEPENDENT HEALTH
NYP010224394OtherROCHESTER BLUE CROSS
NYG0183268190OtherBLUE CHOICE GROUP NUMBER
NY000919915002OtherBLUE CROSS OF WNY
NY000919915002OtherCOMMUNITY BLUE