Provider Demographics
NPI:1134197387
Name:QUAIDOO, EMMANUEL A (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:A
Last Name:QUAIDOO
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 1:10 HAGEN DR STE 330
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2661
Mailing Address - Country:US
Mailing Address - Phone:585-922-8350
Mailing Address - Fax:585-922-8355
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3984
Practice Address - Country:US
Practice Address - Phone:585-442-0150
Practice Address - Fax:585-271-8704
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193211207RR0500X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30936Medicare UPIN
BB0733Medicare ID - Type Unspecified