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Kevin Andrew Douglas, DPM
Foot & Ankle Surgery Podiatrist in Coram, New York
NPI 1174020598

Kevin Andrew Douglas is a Foot & Ankle Surgery Podiatrist based in West Islip, NY and is specialized in Foot & Ankle Surgery. Kevin Andrew Douglas practices in Coram, NY and has the professional credentials of DPM. The NPI Number for Kevin Andrew Douglas is 1174020598 and holds a License No. (New York).

The current practice location address for Kevin Andrew Douglas is 100 Middle Country Rd, Coram, NY and can be reached out via phone at 631-696-9636 and via fax at 631-696-9635.

Location: 100 Middle Country Rd, Coram, NY, 11795-4927
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1174020598
Provider Name
Kevin Andrew Douglas
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
100 Middle Country Rd, Coram, NY, 11795-4927
Phone Number
631-696-9636
Fax Number
631-696-9635
Provider Enumeration Date
04/11/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
100 Middle Country Rd
City
Coram
State
New York
Zip
11727-4412
Phone Number
631-696-9636
Fax Number
631-696-9635
person
Provider Business Mailing Address Details
Address
100 Middle Country Rd
City
Coram
State
New York
Zip
11727-4412
Phone Number
631-696-9636
Fax Number
631-696-9635
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
213ES0103X
License No.
N007168 (New York)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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