Provider Demographics
NPI:1245332600
Name:LIVINGSTON, DOUGLAS JOHN (DPM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOHN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 HADDON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1449
Mailing Address - Country:US
Mailing Address - Phone:854-833-1479
Mailing Address - Fax:856-854-7969
Practice Address - Street 1:2408 RIVERTON RD
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3721
Practice Address - Country:US
Practice Address - Phone:856-829-2101
Practice Address - Fax:856-829-3550
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00187800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1158367OtherHORIZON MERCY
NJ4703405Medicaid
NJ480030233OtherRAILROAD MEDICARE
NJ0389622000OtherAMERIHEALTH
NJ1158367OtherHORIZON MERCY
NJ480030233OtherRAILROAD MEDICARE