Healthcare Provider Details

I. General information

NPI: 1740236090
Provider Name (Legal Business Name): DOUGLAS ROBERT FLETCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MALTESE DR
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

111 MALTESE DR
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4774
  • Fax: 845-818-7555
Mailing address:
  • Phone: 845-342-4774
  • Fax: 845-818-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number177652 1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number177652 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: