Healthcare Provider Details

I. General information

NPI: 1093804684
Provider Name (Legal Business Name): THOMAS C DOWLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 GLENRIDGE RD
GLENVILLE NY
12302-4523
US

IV. Provider business mailing address

PO BOX 31094
HARTFORD CT
06150-1094
US

V. Phone/Fax

Practice location:
  • Phone: 518-952-8142
  • Fax: 518-952-8109
Mailing address:
  • Phone: 518-952-8142
  • Fax: 518-952-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF4010141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: