Provider Demographics
NPI:1265693410
Name:HOM, STACY N (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:N
Last Name:HOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-787-0720
Mailing Address - Fax:585-787-9108
Practice Address - Street 1:1900 EMPIRE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1934
Practice Address - Country:US
Practice Address - Phone:585-787-0720
Practice Address - Fax:585-787-9108
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-11-01
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Provider Licenses
StateLicense IDTaxonomies
NY266736207Q00000X, 207Q00000X
VA0101246367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine