Provider Demographics
NPI:1720550825
Name:DOBSON, MARK CHIPMAN (DTR)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHIPMAN
Last Name:DOBSON
Suffix:
Gender:M
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUGAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6733
Mailing Address - Country:US
Mailing Address - Phone:802-863-2436
Mailing Address - Fax:
Practice Address - Street 1:210 SUGAR TREE LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6733
Practice Address - Country:US
Practice Address - Phone:802-863-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNONE