Provider Demographics
NPI:1487614350
Name:BARATZ, LON K (MD)
Entity type:Individual
Prefix:
First Name:LON
Middle Name:K
Last Name:BARATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:995 SENATOR KEATING BLVD
Mailing Address - Street 2:BLDG E SUITE 3100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-473-1750
Mailing Address - Fax:585-473-4806
Practice Address - Street 1:995 SENATOR KEATING BLVD
Practice Address - Street 2:BLDG E SUITE 3100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-473-1750
Practice Address - Fax:585-473-4806
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY164208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00911739Medicaid
NY14356BMedicare ID - Type Unspecified
NY00911739Medicaid