Provider Demographics
NPI:1841546827
Name:WIEDEL, RACHAEL (PA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:WIEDEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:HOGANCAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:783 POST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2309
Mailing Address - Country:US
Mailing Address - Phone:585-469-8697
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015821363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical