Provider Demographics
NPI:1942232939
Name:DYKMAN, DOUGLAS D (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:DYKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:820 BESTGATE ROAD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-224-2116
Mailing Address - Fax:410-224-2118
Practice Address - Street 1:820 BESTGATE ROAD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-2116
Practice Address - Fax:410-224-2118
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39945207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58701000Medicaid
MDE45679Medicare UPIN
MDH425197TMedicare PIN