Provider Demographics
NPI:1194725788
Name:ADCOCK, BRIAN D (PA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT. 441
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:995 SENATOR KEATING BLVD
Practice Address - Street 2:BUILDING E STE 330
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2775
Practice Address - Country:US
Practice Address - Phone:585-232-2980
Practice Address - Fax:585-232-6522
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY003405-1363A00000X
NY003405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000921754002OtherHEALTH NOW
NY02625818Medicaid
NYPA0314OtherPREFERRED CARE
NY50606000004OtherFIDELIS
NY27164001OtherUNIVERA
NY9512854OtherIHA
NY9747OtherBLUE CROSS BLUE SHIELD
NYP019003405OtherSTRONG CARE
NYP019003405OtherSTRONG CARE
NYP73371Medicare UPIN
DD3360Medicare ID - Type Unspecified