1558465203 NPI number — DOUGLAS ANDREW RING DPM

Table of content: DOUGLAS ANDREW RING DPM (NPI 1558465203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558465203 NPI number — DOUGLAS ANDREW RING DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RING
Provider First Name:
DOUGLAS
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558465203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 LAC DEVILLE BLVD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-244-1150
Provider Business Mailing Address Fax Number:
585-473-9602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 LAC DEVILLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-244-1150
Provider Business Practice Location Address Fax Number:
585-473-9602
Provider Enumeration Date:
09/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N005134 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5576346 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000913681003 . This is a "HEALTHY NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01901959 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101984EQ . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8177 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 301120 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480028081 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010005134 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".