Provider Demographics
NPI:1336185859
Name:KOUIDES, RUTH W (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:W
Last Name:KOUIDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 LONG POND RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4117
Mailing Address - Country:US
Mailing Address - Phone:585-368-4800
Mailing Address - Fax:585-368-4815
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4117
Practice Address - Country:US
Practice Address - Phone:585-368-4800
Practice Address - Fax:585-368-4815
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00967663OtherMEDICARE RR
NYJ400048456/GRP70008AMedicare PIN
NYJ400048457/GRPBA0017Medicare PIN
NYJ400005461Medicare PIN