Provider Demographics
NPI:1003873290
Name:DUELLO, DEBORAH K (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:K
Last Name:DUELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CENTER ST
Mailing Address - Street 2:PO BOX 111
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1437
Mailing Address - Country:US
Mailing Address - Phone:315-764-0265
Mailing Address - Fax:315-764-1812
Practice Address - Street 1:22 CENTER ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1437
Practice Address - Country:US
Practice Address - Phone:315-764-0265
Practice Address - Fax:315-764-1812
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216127207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057427Medicaid
NYRB4396Medicare PIN
NY02057427Medicaid