Provider Demographics
NPI:1548528581
Name:BIDALES, GIORGOS K (MD)
Entity type:Individual
Prefix:
First Name:GIORGOS
Middle Name:K
Last Name:BIDALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-344-7269
Mailing Address - Fax:585-344-7270
Practice Address - Street 1:127 NORTH ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1631
Practice Address - Country:US
Practice Address - Phone:585-344-7269
Practice Address - Fax:585-344-7270
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288126207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN