Provider Demographics
NPI:1376367029
Name:MCGILL, KENDALL MADISON
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:MADISON
Last Name:MCGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 S UNION ST APT 310
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1852
Mailing Address - Country:US
Mailing Address - Phone:315-408-3619
Mailing Address - Fax:
Practice Address - Street 1:4245 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3703
Practice Address - Country:US
Practice Address - Phone:585-389-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program