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General NPI Number Information
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NPI Number | 1700070216
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Entity Type | Organization
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Legal Business Name | DOUGLAS AHN MD PLLC
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 739 IRVING AVE STE 510
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City | SYRACUSE
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State | NY
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Zip | 13210-1663
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Country | US
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Telephone | 315-422-2999
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Fax | 315-422-1141
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Provider Business Mailing Address
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Address Line | 6 RHOADS DR
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City | UTICA
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State | NY
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Zip | 13502-6317
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Country | US
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Telephone | 315-738-7883
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Fax | 315-738-0347
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. DOUGLAS S AHN
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Credential | MD
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Telephone | 315-422-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 229831
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License Number State | NY
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