Provider Demographics
NPI:1437200672
Name:AVELLA, DOUGLAS GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:AVELLA
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 1:140 CHESTNUT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2599
Mailing Address - Country:US
Mailing Address - Phone:201-612-9988
Mailing Address - Fax:201-445-9050
Practice Address - Street 1:140 CHESTNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2599
Practice Address - Country:US
Practice Address - Phone:201-612-9988
Practice Address - Fax:201-445-9050
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03908700207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ81042OtherAMERIGROUP
NJBS472OtherOXFORD
NJ0961576-004OtherCIGNA
NJ1822900Medicaid
NJJ31130OtherHEALTHNET
NJ81D03OtherEMPIRE BCBS
NJC61670Medicare UPIN