Provider Demographics
NPI:1396786968
Name:DOBSON, RICHARD C (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:DOBSON
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 1:2005 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2323
Mailing Address - Country:US
Mailing Address - Phone:585-254-2610
Mailing Address - Fax:
Practice Address - Street 1:2005 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2323
Practice Address - Country:US
Practice Address - Phone:585-254-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135059225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00805587Medicaid
NY10300BMedicare ID - Type Unspecified
NY00805587Medicaid