Provider Demographics
NPI:1962470229
Name:RAGUSA, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:RAGUSA
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 1:1401 STONE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615
Mailing Address - Country:US
Mailing Address - Phone:585-672-4700
Mailing Address - Fax:585-672-4700
Practice Address - Street 1:1401 STONE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615
Practice Address - Country:US
Practice Address - Phone:585-672-4700
Practice Address - Fax:585-672-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY200136207R00000X
NY200136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110141246OtherMEDICARE RR
NY01665190Medicaid
NY01665190Medicaid