Provider Demographics
NPI:1992706402
Name:DETWEILER, ALLAN SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:SCOTT
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:271 DOUGHTY BLVD
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-2135
Mailing Address - Country:US
Mailing Address - Phone:516-371-6884
Mailing Address - Fax:516-371-6083
Practice Address - Street 1:271 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-2135
Practice Address - Country:US
Practice Address - Phone:516-371-6884
Practice Address - Fax:516-371-6083
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205232207Q00000X
FLOS0007505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05V551OtherBLUE CROSS/BLUE SHIELD
NY160447OtherELDERPLAN
NY05V552OtherBLUE CROSS/BLUE SHIELD
NY38780AOtherCIGNA PPO
NY131701OtherCHN CONSUMER HEALTH NET
NY2064925OtherAETNA HMO
NY58-2388280OtherCHOICE CARE HUMANA
NYTAX ID 58-2388280OtherAMER.MEDICAL & LIFE INS.
NY040426008913OtherFIDELIS CARE
NY58-2388280OtherDEVON
NY98413OtherAETNA US HEALTHCARE
NY38780AOtherCIGNA HMO
NY58-2388280OtherBEECH STREET
NY58-2388280OtherEMPIRE PLAN
NY58-2388280 E69914OtherAMERIHEALTH
NY040927000056OtherFIDELIS CARE
NY33565040205232NY01OtherANTHEM HEALTH
NY5235644OtherAETNA PPO/POS PLAN
NYDA5232OtherATLANTIS HEALTH PLAN
NYG66453Medicare UPIN