Provider Demographics
NPI:1518980564
Name:DENNETT, DOUGLAS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:DENNETT
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 1:1322 GERLING ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-1702
Mailing Address - Country:US
Mailing Address - Phone:518-280-4535
Mailing Address - Fax:
Practice Address - Street 1:1322 GERLING ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-1702
Practice Address - Country:US
Practice Address - Phone:518-346-3334
Practice Address - Fax:518-346-4030
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7101614OtherAETNA
NY02495545Medicaid
NY10078428OtherCDPHP
NY710659OtherMVP
NY77022OtherGHI/HMO
NY5264C1OtherEMPIRE BC
NY000404837001OtherBSNENY
NY77022OtherGHI/HMO
NYH96469Medicare UPIN