Provider Demographics
NPI:1598826729
Name:DAGUILH, MARIE-LOUISE FABIENNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE-LOUISE
Middle Name:FABIENNE
Last Name:DAGUILH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3621
Mailing Address - Country:US
Mailing Address - Phone:516-352-2011
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01958070Medicaid
NYG95644Medicare UPIN
NY11V631Medicare ID - Type Unspecified