Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 194867 | NY |
NPI | 1013909167 |
---|---|
Provider Name | Douglas Grant Fish |
First Address | Albany, NY 12209-1750 |
Second Address | Albany, NY 12209-1750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01453007 | (05) | NY |
F48868 | (02) | NY |