Provider Demographics
NPI:1881609659
Name:DUGUE, MARJORIE RENAUD (DO)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:RENAUD
Last Name:DUGUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18435 HENLEY RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2421
Mailing Address - Country:US
Mailing Address - Phone:718-297-9802
Mailing Address - Fax:
Practice Address - Street 1:9050 PARSONS BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6052
Practice Address - Country:US
Practice Address - Phone:718-526-9491
Practice Address - Fax:718-725-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02619556Medicaid
NYI24773Medicare UPIN
NY02619556Medicaid