=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558699405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORINDA MIDWOOD D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2009
-----------------------------------------------------
Last Update Date | 01/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3174 ROUTE 22 HUDSON RIVER HEALTHCARE, INC.
-----------------------------------------------------
City | DOVER PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12522-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-877-4793
-----------------------------------------------------
Fax | 845-877-3139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1037 MAIN ST HUDSON RIVER HEALTHCARE, INC.
-----------------------------------------------------
City | PEEKSKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10566-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-734-8800
-----------------------------------------------------
Fax | 914-734-8786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 050130
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 272728
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------