Provider Demographics
NPI:1225065824
Name:DEGENHARDT, DAVID (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DEGENHARDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HAVELL ST
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3458
Mailing Address - Country:US
Mailing Address - Phone:864-434-2244
Mailing Address - Fax:
Practice Address - Street 1:105 HAVELL ST
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3458
Practice Address - Country:US
Practice Address - Phone:864-434-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232738207P00000X
SC1383207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00879460OtherRAILROAD MEDICARE
NC5916234Medicaid
SC013835Medicaid
SCAA54749068Medicare PIN
SCP00879460OtherRAILROAD MEDICARE