Provider Demographics
NPI:1962460758
Name:FOU, ADORA-ANN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ADORA-ANN
Middle Name:C
Last Name:FOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADORA-ANN
Other - Middle Name:C
Other - Last Name:FOU-COCKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 THEALL RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1404
Mailing Address - Country:US
Mailing Address - Phone:914-848-8960
Mailing Address - Fax:914-848-8965
Practice Address - Street 1:1 THEALL RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1404
Practice Address - Country:US
Practice Address - Phone:914-848-8960
Practice Address - Fax:914-848-8965
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236290-1208600000X
CT044694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02683232Medicaid
NYI34264Medicare UPIN
NY02683232Medicaid