Provider Demographics
NPI:1306094198
Name:SMITH, TIMOTHY PATRICK (RPAC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 S CLINTON AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5720
Mailing Address - Country:US
Mailing Address - Phone:585-442-4310
Mailing Address - Fax:585-442-6750
Practice Address - Street 1:1815 S CLINTON AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5720
Practice Address - Country:US
Practice Address - Phone:585-442-4310
Practice Address - Fax:585-442-6750
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012699-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical