Active NPI
Mario Douyon de Azevedo, M.D.
- Addiction Medicine (Family Medicine) Physician
- Malone, NY
National Provider Identifier
1356562805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Family Medicine) Physician
- License
- 223962-1
- Practice address
- 3878 State Route 11
Suite 2
Malone, NY 12953-3726 - Phone
- (518) 483-6566
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Family Medicine) Physician | 207QA0401X | 223962-1 | NY | Primary |
Addresses
Primary practice location
3878 State Route 11
Suite 2
Malone, NY 12953-3726
Mailing address
3878 State Route 11
Suite 2
Malone, NY 12953-3726
Phone (518) 483-6566
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01943719 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 223962-1 | NY | MD | Addiction Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356562805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3878 STATE ROUTE 11",
"address_2": "SUITE 2",
"city": "MALONE",
"state": "NY",
"postal_code": "129533726",
"telephone_number": "518-483-6566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3878 STATE ROUTE 11",
"address_2": "SUITE 2",
"city": "MALONE",
"state": "NY",
"postal_code": "129533726",
"telephone_number": "518-483-6566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUYON DE AZEVEDO",
"first_name": "MARIO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0401X",
"taxonomy_group": "",
"desc": "Family Medicine, Addiction Medicine",
"state": "NY",
"license": "223962-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01943719",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Malone, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.