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General NPI Number Information
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NPI Number | 1366769804
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Entity Type | Individual
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Provider Name | JOHN CHRISTIAN DOUGLAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 141 N CENTRAL AVE
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City | HARTSDALE
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State | NY
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Zip | 10530-1912
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Country | US
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Telephone | 914-949-7699
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Fax | 914-949-3224
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Provider Business Mailing Address
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Address Line | 208 VALLEY RD
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City | NEW CANAAN
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State | CT
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Zip | 06840-3812
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Country | US
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Telephone | 203-801-2231
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Fax | 203-801-2343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A101028
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 053165
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 269011
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License Number State | NY
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