Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 122394 | NY |
N | 111NI0900X | Internist | 122394 | NY |
N | 207RA0201X | Internist - Allergy & Immunology | 122394 | NY |
N | 207RI0200X | Infectious Disease | 122394 | NY |
NPI | 1639125651 |
---|---|
Provider Name | Dr. Carl Richard Magnussen |
First Address | Rochester, NY 14620-2733 |
Second Address | Rochester, NY 14620-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00456271 | (05) | NY |
1007058Y | PREFERRED CARE (01) | NY |
B71771 | (02) |