Provider Demographics
NPI:1982791695
Name:MAYER, THEODOR KARL (MD PHD)
Entity Type:Individual
Prefix:MR
First Name:THEODOR
Middle Name:KARL
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE ROCHESTER GENERAL HOSPITAL
Mailing Address - Street 2:ROCHESTER GENERAL HEALTH SYSTEM
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-922-9870
Mailing Address - Fax:585-922-9872
Practice Address - Street 1:1425 PORTLAND AVE ROCHESTER GENERAL HOSPITAL
Practice Address - Street 2:ROCHESTER GENERAL HEALTH SYSTEM
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-9870
Practice Address - Fax:585-922-9872
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139022207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00122193OtherVOW RAILROAD MEDICARE
NYRA0343Medicare ID - Type Unspecified
NYBB9618Medicare ID - Type Unspecified
NYF95317Medicare UPIN