Healthcare Provider Details

I. General information

NPI: 1063229458
Provider Name (Legal Business Name): TWIN RIVERS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SOUTHWOODS BLVD
ALBANY NY
12211-2514
US

IV. Provider business mailing address

7 SOUTHWOODS BLVD
ALBANY NY
12211-2514
US

V. Phone/Fax

Practice location:
  • Phone: 518-641-6580
  • Fax: 518-292-6088
Mailing address:
  • Phone: 518-641-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CARL W DOBSON
Title or Position: CHIEF MEDICAL DIRECTOR
Credential:
Phone: 802-447-4535