Provider Demographics
NPI:1497900633
Name:DUCKETT, ADAM G (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:G
Last Name:DUCKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W GARDEN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2662
Mailing Address - Country:US
Mailing Address - Phone:315-567-0777
Mailing Address - Fax:315-702-8393
Practice Address - Street 1:37 W GARDEN ST
Practice Address - Street 2:SUITE #201
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-567-0777
Practice Address - Fax:315-702-8393
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY256831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03229747Medicaid
NYJ400023337Medicare PIN
NYJ400063900Medicare PIN
NY03229747Medicaid