Provider Demographics
NPI:1154352797
Name:DUTTON, FREDERICK LEE (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:LEE
Last Name:DUTTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:F
Other - Middle Name:LEE
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7785 N STATE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1297
Mailing Address - Country:US
Mailing Address - Phone:315-376-5475
Mailing Address - Fax:315-376-5129
Practice Address - Street 1:7785 N STATE ST STE 210
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1297
Practice Address - Country:US
Practice Address - Phone:315-376-5475
Practice Address - Fax:315-376-5129
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21812207V00000X
NY237190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684980Medicaid
NYRA8387Medicare PIN