Provider Demographics
NPI:1962477257
Name:RECORD, DUANE C (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:C
Last Name:RECORD
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 1:206 CORNELIA ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2779
Mailing Address - Country:US
Mailing Address - Phone:518-566-9452
Mailing Address - Fax:518-562-7189
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 306
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-566-9452
Practice Address - Fax:518-562-7189
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00650959Medicaid
NYB80756Medicare UPIN
NM00650959Medicaid