Provider Demographics
NPI:1144310632
Name:SMOLLER, BRUCE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SMOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:601 ELMWOOD AVENUE
Mailing Address - Street 2:URMC BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-275-3184
Mailing Address - Fax:585-276-2047
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:UNIVERSITY OF ROCHESTER MEDICAL CENTER, BOX 626
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3184
Practice Address - Fax:585-276-2047
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-1327207ZD0900X, 207ZP0102X
NY168963207ZD0900X
VT042.0012190207ZD0900X
NY168963-1207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR220019705OtherRAILROAD MEDICARE
AR131598001Medicaid
AR220019705OtherRAILROAD MEDICARE
A61101Medicare UPIN
AR131598001Medicaid