Healthcare Provider Details
I. General information
NPI: 1144399031
Provider Name (Legal Business Name): MATTHEW M DUGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/07/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
537 N STATE RD CARE MOUNT MEDICAL PC
BRIARCLIFF MANOR NY
10510-1573
US
IV. Provider business mailing address
110 S BEDFORD RD CARE MOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US
V. Phone/Fax
- Phone: 914-941-2129
- Fax: 914-941-1969
- Phone: 914-241-1050
- Fax: 914-941-1969
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 235954 |
| License Number State | NY |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | BLUE CROSS/BLUE SHIELD |
| # 2 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | OXFORD |
| # 3 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | UNITED HEALTH CARE |
| # 4 | |
| Identifier | 02560649 |
| Identifier Type | MEDICAID |
| Identifier State | NY |
| Identifier Issuer | |
| # 5 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | AETNA |
| # 6 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | ATLANTIS HEALTH PLAN |
| # 7 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | PHCS |
| # 8 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | MULTIPLAN |
| # 9 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | HEALTHNET |
| # 10 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | UNITED HEALTH CARE/EMPIRE PLAN |
| # 11 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | POMCO |
| # 12 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | CIGNA |
| # 13 | |
| Identifier | 1144399031 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | MVP |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
