| Doctor Name: | DOUGLAS E PROVOST |
| NPI Number: | 1386633634 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 134188 |
| Business Practice Address: | 161 Carey Rd Queensbury, NY - 128047821 |
| Business Phone Number: | 5188248610 |
| Business Fax Number: | |
| Mailing Address: | 9 Carey Rd, QUEENSBURY |
| State: | NY |
| Postal Code: | 128047880 |
| Phone Number: | 5187610300 |
| Fax Number: | 5188242388 |
| NPI Enumeration Date: | 10/19/2005 |
| NPI Last Update Date: | 12/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 134188 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |