Provider Demographics
NPI:1013304070
Name:UNIVERSAL DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:UNIVERSAL DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:SHEILA
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-953-3620
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3503
Mailing Address - Country:US
Mailing Address - Phone:585-953-3620
Mailing Address - Fax:
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD STE 150
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3503
Practice Address - Country:US
Practice Address - Phone:585-953-3620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248998207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB8929Medicare PIN
NYRB8928Medicare PIN