Internal Medicine at Lakeside

NPI #1083939722 in Brockport, New York

Provider Information

NPI Number: 1083939722
Entity Type: Organization
Organization Name: Internal Medicine at Lakeside
Subpart: Yes (part of a larger organization)
Parent Organization: LAKESIDE MEMORIAL HOSPITAL
Primary Specialty: Internal Medicine
Enumeration Date: Apr 6, 2010
Last Updated: Apr 6, 2010

Practice Location

Address: 156 WEST AVE
Address 2: SUITE 106
City: Brockport
State: New York
ZIP Code: 14420-1229
Phone: (585) 395-6095

Authorized Official

Name: MRS. NANCY M WILSON
Title: PHYSICIAN PRACTICES
Phone: (585) 395-6095

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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