Provider Demographics
NPI:1013984723
Name:DRUGER, ROBERT K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:DRUGER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1324
Mailing Address - Country:US
Mailing Address - Phone:315-488-1601
Mailing Address - Fax:315-488-0047
Practice Address - Street 1:5633 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031
Practice Address - Country:US
Practice Address - Phone:315-488-1601
Practice Address - Fax:315-488-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210355-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856615Medicaid
NYG78802Medicare UPIN
NY5244700002Medicare NSC
NYRA2825Medicare PIN
NY01856615Medicaid
NY56425HMedicare PIN