Provider Demographics
NPI:1922650183
Name:REMELT, PARKER CHARLES
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:CHARLES
Last Name:REMELT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WHITE SPRUCE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1619
Mailing Address - Country:US
Mailing Address - Phone:585-275-2838
Mailing Address - Fax:585-424-1338
Practice Address - Street 1:400 WHITE SPRUCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1619
Practice Address - Country:US
Practice Address - Phone:585-275-2838
Practice Address - Fax:585-424-1338
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant