Provider Demographics
NPI:1538123922
Name:DY-GUILLAUME, MARIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:E
Last Name:DY-GUILLAUME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 JUSTICE AVE STE CS
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-8715
Mailing Address - Country:US
Mailing Address - Phone:718-779-9599
Mailing Address - Fax:
Practice Address - Street 1:8708 JUSTICE AVE STE CS
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-8715
Practice Address - Country:US
Practice Address - Phone:718-779-9599
Practice Address - Fax:718-779-9579
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201321207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01788994Medicaid
NYG400002156OtherMEDICARE PTAN
NYG400002156OtherMEDICARE PTAN
NY01788994Medicaid