Provider Demographics
NPI:1265545693
Name:WIEFLING, BRIDGETTE ANN (MD)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:ANN
Last Name:WIEFLING
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 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-4430
Mailing Address - Fax:585-922-1399
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4430
Practice Address - Fax:585-922-1399
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236522208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY172800BJOtherPREFERRED CARE
NYP010236522OtherBLUE CROSS OF ROCHESTER
NY01130026/RGHMedicaid
NY03406397/WNYMedicaid
NY236522Medicaid
NY01131126/RGHMedicaid
NY03007072/OPDMedicaid
NYP010236522OtherBLUE CHOICE OF ROCHESTER
NY03007072/OPDMedicaid
NYP010236522OtherBLUE CROSS OF ROCHESTER
NYJ400083623Medicare PIN
NY236522Medicaid
NY03406397/WNYMedicaid
NY01130026/RGHMedicaid