DOUGLAS E PROVOST MD NPI 1386633634

NPI Information

  • NPI: 1386633634
  • Provider Name: DOUGLAS E PROVOST, MD
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Individual
  • CLIA Number: 33D1055507
  • Address: 161 CAREY RD
    QUEENSBURY, NY
    ZIP 12804
  • Phone: (518) 824-8610

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NPI Details

Douglas E Provost, MD is an obstetrics gynecology in Queensbury, NY. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. Douglas E Provost, MD NPI is 1386633634. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

161 CAREY RD
QUEENSBURY, NY
ZIP 12804-821
Phone: (518) 824-8610

The CLIA number assigned to this NPI record is 33D1055507 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/19/2005 and was last updated on 12/22/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology134188NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B82190MEDICARE UPIN
216454OTHERMVP
300460999MEDICAIDNEW YORK
4000405036002OTHERBLUE SHIELD
510001652OTHERCDPHP
638780BMEDICARE PINNEW YORK
7DP077E5610OTHEREBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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