Douyon De Azevedo, Mario
Douyon De Azevedo, Mario is an sole proprietor health care provider with primary practice located at 3878 State Route 11 Suite 2, Malone NY 12953-3726. He recently has only one registered license in Allopathic & Osteopathic Physicians / Addiction Medicine, which is considered as his primary health care specialty. Douyon De Azevedo, Mario can be contacted via phone (518) 483-6566.Contact Information
Primary practice address
3878 State Route 11 Suite 2
Malone NY 12953-3726
Phone: (518) 483-6566
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Addiction Medicine | 207QA0401X | 223962-1 | New York |
Profile Details
| NPI number | 1356562805 |
|---|---|
| LBN Legal business name | Douyon De Azevedo, Mario |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 1st, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356562805 | NPPES |
| New York | MEDICAID | 01943719 |
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