Deirdre Duffy, M.D.

Key facts

NPI

1962475426

Entity type

Individual (NPI type 1)

Primary specialty

Obstetrics & Gynecology Physician 207V00000X

License

48442 (WI)

Practice address

109 Air Park Dr
Watertown, WI 53094-7400

Phone

(262) 928-5100

NPI assigned

Feb 7, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prohealth Medical Group Inc Family Medicine Physician · Waukesha, WI · NPI 1790720613
  NPD (past) OBSTETRICS & GYNECOLOGY

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 9, 2010.

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291852800000",
    "number": "1962475426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 AIR PARK DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530947400",
            "telephone_number": "262-928-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 AIR PARK DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530947400",
            "telephone_number": "262-928-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFFY",
        "first_name": "DEIRDRE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-07",
        "last_updated": "2010-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "48442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34688900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Watertown, WI · Obstetrics & Gynecology Physician in Wisconsin