Provider Demographics
NPI:1003874322
Name:BARATTA, BRENDA B (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:B
Last Name:BARATTA
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 1:2021 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3957
Mailing Address - Country:US
Mailing Address - Phone:585-784-6400
Mailing Address - Fax:585-341-2370
Practice Address - Street 1:2021 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3957
Practice Address - Country:US
Practice Address - Phone:585-784-6400
Practice Address - Fax:585-341-2370
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NY051006000000OtherFIDELIS
NYP010179630OtherBCBS
NY110242023OtherMEDICARE RAILROAD
NY00027338101OtherUNIVERA
NY106276BJOtherPREFERRED CARE
NY11121547OtherCAQH
NY00355266Medicaid
NY116824Medicare ID - Type Unspecified