Provider Demographics
NPI:1770691487
Name:KERR, DOUGLAS ROBERT (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:KERR
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 1:65 PENNSYLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-723-5393
Mailing Address - Fax:607-771-0803
Practice Address - Street 1:65 PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-723-5393
Practice Address - Fax:607-771-0803
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142012207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00819874Medicaid
34739HMedicare Oscar/Certification
NY00819874Medicaid