Provider Demographics
NPI:1780617746
Name:AHARON, ALON S (MD)
Entity type:Individual
Prefix:
First Name:ALON
Middle Name:S
Last Name:AHARON
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 1:1351 ROUTE 55 STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5128
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:1 COLUMBIA ST STE 300
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3924
Practice Address - Country:US
Practice Address - Phone:845-483-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046078208G00000X
PAMD423564208G00000X
NY240802208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05010971Medicaid
OHP00392658OtherRAILROAD MEDICARE
000000221018OtherUNISON
OHAH4176681Medicare PIN
363303OtherWELLCARE
7864278OtherAETNA
AH4176682Medicare PIN
741755OtherBUCKEYE
F40025Medicare UPIN
OH2639783Medicaid