Provider Demographics
NPI:1417928698
Name:ALDEN, DMITRI (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRI
Middle Name:
Last Name:ALDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6707
Mailing Address - Country:US
Mailing Address - Phone:845-452-2120
Mailing Address - Fax:845-452-2104
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6707
Practice Address - Country:US
Practice Address - Phone:845-452-2120
Practice Address - Fax:845-452-2104
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2298922086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI00505Medicare UPIN
NY2450H2Medicare PIN