Basic Information
| Provider Information | |||||||||
| NPI: | 1548419351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOUGEE | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | M | ||||||||
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| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5008 BRITTONFIELD PKWY STE 700 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130579249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154727504 | ||||||||
| FaxNumber: | 3156344677 | ||||||||
| Practice Location | |||||||||
| Address1: | 5008 BRITTONFIELD PKWY STE 700 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130579249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154727504 | ||||||||
| FaxNumber: | 3156344677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PENDING | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 03152614 | 05 | NY | MEDICAID |