Provider Demographics
NPI:1962415372
Name:MCKANE, DOUGLAS DENTON (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DENTON
Last Name:MCKANE
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 1:812 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2113
Mailing Address - Country:US
Mailing Address - Phone:607-732-3867
Mailing Address - Fax:
Practice Address - Street 1:812 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2113
Practice Address - Country:US
Practice Address - Phone:607-732-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101372-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery