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General NPI Number Information
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NPI Number | 1437299237
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Entity Type | Individual
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Provider Name | SAMUEL DEAN DETWEILER MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 331 BRIDGE ST ST. MARY'S HOSPITAL, NORTHVILLE FAMILY HEALTH CENTER
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City | NORTHVILLE
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State | NY
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Zip | 12134
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Country | US
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Telephone | 518-863-4200
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Fax | 518-863-4787
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Provider Business Mailing Address
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Address Line | 427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT. ST. MARY'S HOSPITAL AT AMSTERDAM
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City | AMSTERDAM
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State | NY
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Zip | 12010
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Country | US
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Telephone | 518-841-7430
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Fax | 518-841-7121
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 157873
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 157873
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License Number State | NY
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