Provider Demographics
NPI:1164520169
Name:HYDE, DOUGLAS KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KEITH
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:86 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1660
Mailing Address - Country:US
Mailing Address - Phone:413-567-3084
Mailing Address - Fax:413-747-0443
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 419
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-737-7951
Practice Address - Fax:413-747-0443
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52499207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6182992Medicaid
MA6182992Medicaid