Provider Demographics
NPI:1720049158
Name:TOURTELOT, ELLEN J (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:TOURTELOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2691
Mailing Address - Fax:585-242-8707
Practice Address - Street 1:125 LATTIMORE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4159
Practice Address - Country:US
Practice Address - Phone:585-275-2691
Practice Address - Fax:585-242-8707
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177827207V00000X
PAMD050297L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE96675Medicare UPIN