Dr. Mario Douyon De Azevedo
Family Doctor - Addiction Medicine
3878 State Route 11 Suite 2
Malone
, New York 12953-3726
Dr. Mario Douyon De Azevedo
Family Doctor - Addiction Medicine
3878 State Route 11 Suite 2
Malone
, New York 12953-3726
(518) 483-6566
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About
Features
Specialties
- Family Doctor - Addiction Medicine
Languages spoken
- English
Location
First Address
- Dr. Mario Douyon De Azevedo
- 3878 State Route 11 Suite 2
- Malone, NY
- Zip : 12953-3726
- Phone : (518) 483-6566
Second Address
- Dr. Mario Douyon De Azevedo
- 3878 State Route 11 Suite 2
- Malone, NY
- Zip : 12953-3726
- Phone : (518) 483-6566
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0401X | Family Doctor - Addiction Medicine | 223962-1 | NY |
National Provider Identifier
| NPI | 1356562805 |
|---|---|
| Provider Name | Dr. Mario Douyon De Azevedo |
| First Address | Malone, NY 12953-3726 |
| Second Address | Malone, NY 12953-3726 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/05/2007 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 01943719 | (05) | NY |
| G90729 | (02) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.