Fetkenhour, Douglas R

Fetkenhour, Douglas R is an individual health care provider with primary practice located at 4901 Lac De Ville Blvd Ste 250 , Rochester NY 14618. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner, Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Fetkenhour, Douglas R can be contacted via phone (585) 275-3271.

Contact Information

Primary practice address
4901 Lac De Ville Blvd Ste 250 Rochester NY 14618
Phone: (585) 275-3271
Fax: (585) 442-2949
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner 225400000X 235170 New York
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 235170 New York

Profile Details

NPI number 1326023128
LBN Legal business name Fetkenhour, Douglas R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Jul 5th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326023128 NPPES
New York MEDICAID 02695178

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