Provider Demographics
NPI:1619934858
Name:CLINE, DOUGLAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:CLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:104 MAIN ST
Mailing Address - Street 2:DOUGLAS C CLINE, M.D., P.C.
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-4055
Mailing Address - Country:US
Mailing Address - Phone:518-223-0812
Mailing Address - Fax:518-223-0813
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:DOUGLAS C CLINE, M.D., P.C.
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-4055
Practice Address - Country:US
Practice Address - Phone:518-223-0812
Practice Address - Fax:518-223-0813
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA59582174400000X
NJMA059582207Q00000X
NY231033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5569702Medicaid
NJ5569702Medicaid