Provider Demographics
NPI:1174549927
Name:DUCREST, ANTOINETTE (MD)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:DUCREST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1152
Mailing Address - Country:US
Mailing Address - Phone:302-577-2484
Mailing Address - Fax:
Practice Address - Street 1:14 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1152
Practice Address - Country:US
Practice Address - Phone:302-577-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI462692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34543900Medicaid
F90823Medicare UPIN