Provider Demographics
NPI:1336198084
Name:HAUGH, KATHRYN B (MSSNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:HAUGH
Suffix:
Gender:F
Credentials:MSSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WHITE SPRUCE BLVD # 600
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1607
Mailing Address - Country:US
Mailing Address - Phone:585-461-5940
Mailing Address - Fax:
Practice Address - Street 1:125 WHITE SPRUCE BLVD # 600
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1607
Practice Address - Country:US
Practice Address - Phone:585-461-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420278363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400011652Medicare PIN