Provider Demographics
NPI:1811045107
Name:DAUDI, IMBESAT A (MD)
Entity Type:Individual
Prefix:DR
First Name:IMBESAT
Middle Name:A
Last Name:DAUDI
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 1:140 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3102
Mailing Address - Country:US
Mailing Address - Phone:207-768-4562
Mailing Address - Fax:207-768-4560
Practice Address - Street 1:301 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2220
Practice Address - Country:US
Practice Address - Phone:607-733-1156
Practice Address - Fax:607-737-7968
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14600208800000X
NY194160208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1285892778Medicaid
NY04037472Medicaid
NY04037472Medicaid