Andrew Walter Douglas, RPA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

011617 Issued in NY

Practice address

3Rd Ave and 183Rd STR
Bronx, NY 10457-2594

Phone

(718) 960-9000

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: and9133@direct.nyp.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649335274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 W 148TH ST",
            "address_2": "APT 2A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100392915",
            "telephone_number": "570-660-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3RD AVE AND 183RD STR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104572594",
            "telephone_number": "718-960-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "ANDREW",
        "middle_name": "WALTER",
        "name_prefix": "Mr.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "011617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jean Dougherty, D.M.D.
• Serniqua Dougherty
• Douglas Bennet Herzlich DPM PC
• Alexandra Welch Douglas, MD-MPH
• Alina Douglas
• Gaveral Douglas
• Gregory Landells Douglas, LCSW
• Gretchen Douglas
• Jennifer Douglas, OTD, OTR/L
• Karimah Ayana Douglas, OTR

• Surgical Physician Assistant in Bronx, NY
• Providers in Bronx, NY by specialty
• Surgical Physician Assistant in New York

• 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.

Verify at the official NPI Registry.