Provider Demographics
NPI:1720072556
Name:DEGELSMITH, LAURENCE M (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:M
Last Name:DEGELSMITH
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 1:400 EAST MAIN STREET
Mailing Address - Street 2:NORTHERN WESTCHESTER HOSPITAL MEDICAL AFFAIRS
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-666-1200
Mailing Address - Fax:914-666-1965
Practice Address - Street 1:400 EAST MAIN STREET
Practice Address - Street 2:NORTHERN WESTCHESTER HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-1254
Practice Address - Fax:914-666-1931
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0607010000011OtherFIDELIS CARE OF NY PIN
000000106184OtherGHI HMO
4147747OtherMVP
P2831171OtherOXFORD
0112885OtherGHI PPO
7391237OtherAETNA PPO
10051435D815OtherCAPITAL DISTR
3917852OtherAETNA HMO
5C7510OtherHEALTHNET
828481OtherBCBS
NY01814759Medicaid
G54859Medicare UPIN
NY01814759Medicaid