Provider Demographics
NPI:1649483181
Name:WAKEMAN, DEREK STEVEN (MD)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:STEVEN
Last Name:WAKEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX SURG
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-1753
Mailing Address - Fax:585-276-2370
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX SURG
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-1753
Practice Address - Fax:585-276-2370
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2006015616208600000X
NY2831922086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery