Provider Demographics
NPI:1174529747
Name:ALWEIS, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:ALWEIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1561 LONG POND ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4135
Mailing Address - Country:US
Mailing Address - Phone:585-368-4800
Mailing Address - Fax:585-368-4815
Practice Address - Street 1:1561 LONG POND ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4135
Practice Address - Country:US
Practice Address - Phone:585-368-4800
Practice Address - Fax:585-368-4815
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2017-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY283973207R00000X
PAMD432849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04453738Medicaid
NY04453738Medicaid
NYJ400339015-GRPBA0017Medicare PIN