Provider Demographics
NPI:1801847264
Name:FINEFROCK, DOUGLAS C (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:FINEFROCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-3547
Mailing Address - Fax:
Practice Address - Street 1:3000 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5335
Practice Address - Country:US
Practice Address - Phone:513-870-7001
Practice Address - Fax:513-603-8174
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09066300207P00000X
OH34008054207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000316069OtherBCBS FAIRFIELD
P00083370OtherRR MEDICARE FAIRFIELD
OH2424746Medicaid
H90622Medicare UPIN
FI4112952Medicare PIN
P00083370OtherRR MEDICARE FAIRFIELD