Basic Information
| Provider Information | |||||||||
| NPI: | 1710914742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILLART | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 FOOTE AVE | ||||||||
| Address2: | DEPT OF ANESTHESIA | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147017077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164870141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 207 FOOTE AVE | ||||||||
| Address2: | DEPT OF ANESTHESIA | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147017077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164870141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 183836-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A53523 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | ME144682 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 183836 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01507377 | 05 | NY | MEDICAID |