Provider Demographics
NPI:1063589851
Name:HOBBS, DAVID W (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:HOBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 US RT #2
Mailing Address - Street 2:
Mailing Address - City:SOUTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05486
Mailing Address - Country:US
Mailing Address - Phone:802-372-4687
Mailing Address - Fax:
Practice Address - Street 1:564 US RT #2
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486
Practice Address - Country:US
Practice Address - Phone:802-372-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170291-1207P00000X
VT0420006849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141338471OtherFIDELIS
NY141338471OtherAETNA
NY90031OtherMVP
NY114406OtherVALUE OPTIONS
NY141338471OtherEXCELLUS
NY141338471OtherGHI
61Q881OtherEMPIRE BC
141338471OtherUNITED HEALTHCARE
NY000490094001OtherBSNENY
NY01192281Medicaid
NY141338471OtherMARTINS POINT
NY114406OtherVALUE OPTIONS
141338471OtherUNITED HEALTHCARE
NY141338471OtherMARTINS POINT