Provider Demographics
NPI:1427129543
Name:MACQUEEN, DOUGLAS D (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:MACQUEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1863
Mailing Address - Country:US
Mailing Address - Phone:607-241-1118
Mailing Address - Fax:607-257-2923
Practice Address - Street 1:16 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1863
Practice Address - Country:US
Practice Address - Phone:607-241-1118
Practice Address - Fax:607-257-2923
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC-06-1069207R00000X
ME018144208M00000X, 207R00000X
NY265017207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30208728Medicaid
ME434249299Medicaid
MEP00771396Medicare PIN
ME001169101Medicare PIN