Provider Demographics
NPI:1477576585
Name:DRYDEN, DAWN K (DPM)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 W MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9467
Mailing Address - Country:US
Mailing Address - Phone:585-344-1677
Mailing Address - Fax:585-344-2105
Practice Address - Street 1:3922 W MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9467
Practice Address - Country:US
Practice Address - Phone:585-344-1677
Practice Address - Fax:585-344-2105
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005507213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
051203000030OtherFIDELIS
P010005507OtherBLUE CHOICE
000525583002OtherBCWNY
480033099OtherRR MEDICARE
7029140OtherAETNA
NY01918212Medicaid
1400042OtherPC GROUP
8990460OtherIH
MDE614OtherPC
000525583003OtherBCWNY DME
NY02205076Medicaid
00020520501OtherCHOICE CARE
1499717OtherGHI
9648089OtherGHI GROUP
G0181304190OtherBLUE CHOICE GRP
000525583002OtherCB
NY01918212Medicaid
P010005507OtherBLUE CHOICE
NYAA1027Medicare ID - Type UnspecifiedGROUP
NY02205076Medicaid