| Mr Samuel Dean Detweiler, MD | |
|
331 Bridge St, St. Mary's Hospital, Northville Family Health Center, Northville, NY 12134 | |
| (518) 863-4200 | |
| (518) 863-4787 |
| Full Name | Mr Samuel Dean Detweiler |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 45 Years |
| Location | 331 Bridge St, Northville, New York |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437299237 | NPI | - | NPPES |
| 000419006006 | Other | NY | BS PROVIDER NUMBER |
| 77787 | Other | NY | MVP |
| 040426006943 | Other | NY | FIDELIS |
| 10000485 | Other | NY | CDPHP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 157873 (New York) | Secondary |
| 207Q00000X | Family Medicine | 157873 (New York) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Living Resources Chha | Albany, NY | Home health agency |
| St Mary's Healthcare | Amsterdam, NY | Hospital |
| Nathan Littauer Hospital | Gloversville, NY | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| St. Mary's Healthcare | 7618960709 | 119 |
| Entity Name | St. Mary's Healthcare |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1518926401 PECOS PAC ID: 7618960709 Enrollment ID: O20040405001628 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Samuel Dean Detweiler, MD 427 Guy Park Ave - Primary & Specialty Care Dept., St. Mary's Hospital At Amsterdam, Amsterdam, NY 12010 Ph: (518) 841-7430 | Mr Samuel Dean Detweiler, MD 331 Bridge St, St. Mary's Hospital, Northville Family Health Center, Northville, NY 12134 Ph: (518) 863-4200 |
Victor Nikolsky, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 385 S Shore Rd, Northville, NY 12134 Phone: 518-883-8585 |