Provider Demographics
NPI:1710059324
Name:CAVALLARO, CHARLES T (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:CAVALLARO
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:41 MONROE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3007
Mailing Address - Country:US
Mailing Address - Phone:585-727-3333
Mailing Address - Fax:585-456-1944
Practice Address - Street 1:3300 MONROE AVE STE 325
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4623
Practice Address - Country:US
Practice Address - Phone:585-727-3333
Practice Address - Fax:585-456-1944
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD6379Medicare PIN
E97033Medicare UPIN