Provider Demographics
NPI: | 1700070216 |
---|---|
Name: | DOUGLAS AHN MD PLLC |
Entity Type: | Organization |
Organization Name: | DOUGLAS AHN MD PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICIAN/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DOUGLAS |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | AHN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 315-422-2999 |
Mailing Address - Street 1: | 6 RHOADS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | UTICA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 13502-6317 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 315-738-7883 |
Mailing Address - Fax: | 315-738-0347 |
Practice Address - Street 1: | 739 IRVING AVE STE 510 |
Practice Address - Street 2: | |
Practice Address - City: | SYRACUSE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 13210-1663 |
Practice Address - Country: | US |
Practice Address - Phone: | 315-422-2999 |
Practice Address - Fax: | 315-422-1141 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-08-29 |
Last Update Date: | 2008-05-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 229831 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |