=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487972923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS C. CLINE, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2010
-----------------------------------------------------
Last Update Date | 05/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 MAIN ST
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-223-0812
-----------------------------------------------------
Fax | 518-223-0813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1902
-----------------------------------------------------
City | BOLTON LANDING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12814-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-223-0812
-----------------------------------------------------
Fax | 518-223-0813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DOUGLAS C. CLINE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 518-223-0812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------