Provider Demographics
NPI:1699143800
Name:TWIN RIVERS MEDICAL PC
Entity type:Organization
Organization Name:TWIN RIVERS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL (TREY)
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-447-5208
Mailing Address - Street 1:16 DANFORTH ST
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-1226
Mailing Address - Country:US
Mailing Address - Phone:518-686-5770
Mailing Address - Fax:
Practice Address - Street 1:16 DANFORTH ST
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090-1226
Practice Address - Country:US
Practice Address - Phone:518-686-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty