Provider Demographics
NPI:1649247511
Name:ROLLS, WILLIAM P (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:ROLLS
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:
Practice Address - Street 1:1338 E RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2018
Practice Address - Country:US
Practice Address - Phone:585-922-7140
Practice Address - Fax:585-336-9029
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00833578Medicaid
NY110158680OtherRAILROAD MEDICARE
NY110158680OtherRAILROAD MEDICARE
NY00833578Medicaid