Healthcare Provider Details

I. General information

NPI: 1679526669
Provider Name (Legal Business Name): CHRISTIAN D. TVETENSTRAND MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARRISON ST SUITE 320
JOHNSON CITY NY
13790-2161
US

IV. Provider business mailing address

30 HARRISON ST SUITE 320
JOHNSON CITY NY
13790-2161
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-8205
  • Fax: 607-763-8208
Mailing address:
  • Phone: 607-763-8205
  • Fax: 607-763-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number178438
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011154
License Number StateNY

VIII. Authorized Official

Name: CHRISTIAN DAHN TVETENSTRAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 607-763-8205