Healthcare Provider Details

I. General information

NPI: 1629163423
Provider Name (Legal Business Name): ROBERT DWIGHT SEMLEAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GARAGE PLACE RD
GHENT NY
12075-1203
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-1177
  • Fax: 518-392-1199
Mailing address:
  • Phone: 518-392-1177
  • Fax: 518-392-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number143638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: