| Douglas Ahn, M.d., P.l.l.c. | |
|
122 Business Park Dr Suite 1 Utica NY 13502-6321 | |
| (315) 738-7883 | |
| (315) 738-0347 |
| Full Name | Douglas Ahn, M.d., P.l.l.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 122 Business Park Dr, Utica, New York |
| Authorized Official Name and Position | Douglas Ahn (PRESIDENT) |
| Authorized Official Contact | 3157387883 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas Ahn, M.d., P.l.l.c. 122 Business Park Dr Suite 1 Utica NY 13502-6321 Ph: (315) 738-7883 | Douglas Ahn, M.d., P.l.l.c. 122 Business Park Dr Suite 1 Utica NY 13502-6321 Ph: (315) 738-7883 |
| NPI Number | 1104018191 |
|---|---|
| Provider Enumeration Date | 08/14/2007 |
| Last Update Date | 09/26/2012 |
| Medicare PECOS PAC ID | 3577640499 |
|---|---|
| Medicare Enrollment ID | O20080402000656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104018191 | NPI | - | NPPES |
| 02614184 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 229831 (New York) | Primary |
| Provider Name | Douglas Ahn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609934025 PECOS PAC ID: 8921098161 Enrollment ID: I20040518000540 |
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