Healthcare Provider Details

I. General information

NPI: 1699143800
Provider Name (Legal Business Name): TWIN RIVERS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DANFORTH ST
HOOSICK FALLS NY
12090-1226
US

IV. Provider business mailing address

16 DANFORTH ST
HOOSICK FALLS NY
12090-1226
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-5770
  • Fax:
Mailing address:
  • Phone: 518-686-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARL (TREY) DOBSON
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: MD
Phone: 802-447-5208