DR. MARIO DOUYON DE AZEVEDO (NPI# 1356562805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356562805 |
| Entity Type | Individual |
| Full Name | DR. MARIO DOUYON DE AZEVEDO |
| Credential | M.D. |
| Practice Address |
3878 State Route 11 Suite 2 Malone NY 12953-3726 |
| Practice Telephone | 5184836566 |
| Mailing Telephone | 5184836566 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
223962-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01943719 | 05 |
| Street Address |
3878 STATE ROUTE 11 SUITE 2 |
| City | MALONE |
| State | NY |
| Zip Code | 12953-3726 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386264356 | Ruth Ann Williamson | Nurse Practitioner | 31 Sixth St., Malone, NY 12953 | 2020-04-20 |
| 1780203760 | Heather Lynn Lauzon | Peer Specialist | 15 Fouth St, Malone, NY 12953 | 2020-04-10 |
| 1245717115 | Darlean James | Family Medicine | 183 Park St Ste 5678, Malone, NY 12953 | 2018-07-24 |
| 1164929212 | Cheryl Ann Grant | Registered Nurse | 15 Fourth Street, Malone, NY 12953 | 2018-04-06 |
| 1811408826 | Nancy Denis | Registered Nurse | 133 Park Street, Alice Hyde Medical Center, Malone, NY 12953 | 2017-10-17 |
| 1003325424 | Tara Lynn Ellis | Registered Nurse | 23 Husky Lane, Malone, NY 12953 | 2017-09-28 |
| 1578092185 | Shanna Lee Cayea | Peer Specialist | 31 6th Street, Malone, NY 12953 | 2017-06-07 |
| 1184007809 | Alice Hyde Medical Center | Home Health | 45 Sixth St, Malone, NY 12953 | 2015-06-30 |
| 1427303353 | Melissa J Benardot | Nurse Practitioner | 380 Cty Rt 57, Community Health Center, Malone, NY 12953 | 2012-07-17 |
| 1013272202 | Shafiu Oladele Ololade | Internal Medicine | 10 Third Street, Malone, NY 12953 | 2012-07-12 |
| Find all providers in zip 12953 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053921957 | Titan Primary Care, Inc | Family Medicine | 3753 90th St Ste 11, Jackson Heights, NY 11372-7879 | 2020-08-05 |
| 1205467842 | Tara Healthcare LLC | Family Medicine | 157 Bleecker St # 1, New York, NY 10012-1625 | 2020-02-03 |
| 1548820608 | Cs Medical Associates, P.C. | Family Medicine | 727 N Broadway Ste B1, Massapequa, NY 11758-2348 | 2019-06-19 |
| 1992210231 | Cs Medical Associates, PC | Family Medicine | 100 Granny Road, Suite 2, Farmingville, NY 11738 | 2017-12-08 |
| 1881120376 | Yonina Mar | Family Medicine | 10 Nathan D. Perlman Pl, Msbi Psychiatry, Bernstein Pavilion, Room 7b15, New York, NY 10003 | 2017-05-03 |
| 1457771842 | Gary Demara | Family Medicine | 220 Tom Miller Rd, Plattsburgh, NY 12901-6427 | 2014-04-24 |
| 1144540022 | Michael James Reardon | Family Medicine | 41 Dunlop Rd, Huntington, NY 11743-3932 | 2010-06-02 |
| 1710123963 | Fred William Marcus | Family Medicine | 770 Jericho Tpke, Syosset, NY 11791-4516 | 2008-12-17 |
| 1740447101 | Bernard Charles Borkowski | Family Medicine | 2025 Kenneth Rd, Merrick, NY 11566-5508 | 2008-05-21 |
| 1023280740 | Charles Pouponneau | Family Medicine | 147-20 Archer Avenue, Jamaica, NY 11435 | 2008-04-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.