Provider Demographics
NPI:1194792960
Name:DINNAN, MARY A (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:DINNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1338 E RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2018
Mailing Address - Country:US
Mailing Address - Phone:585-922-7140
Mailing Address - Fax:585-336-9029
Practice Address - Street 1:1338 E RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2018
Practice Address - Country:US
Practice Address - Phone:585-922-7140
Practice Address - Fax:585-336-9029
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954145Medicaid
NYBB6605Medicare PIN
NYR82680Medicare UPIN