Provider Demographics
NPI:1083608665
Name:WERNER, DONALD M (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:WERNER
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 1:1942 MILITARY TPKE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7375
Mailing Address - Country:US
Mailing Address - Phone:518-310-3644
Mailing Address - Fax:518-310-3645
Practice Address - Street 1:1942 MILITARY TPKE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7375
Practice Address - Country:US
Practice Address - Phone:518-310-3644
Practice Address - Fax:518-310-3645
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096889207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11124926OtherCAQH
NY00577413Medicaid
NYB78319Medicare UPIN
NYRB7142Medicare PIN