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General NPI Number Information
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NPI Number | 1679526669
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Entity Type | Organization
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Legal Business Name | CHRISTIAN D. TVETENSTRAND MD, PLLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 30 HARRISON ST SUITE 320
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2161
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Country | US
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Telephone | 607-763-8205
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Fax | 607-763-8208
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Provider Business Mailing Address
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Address Line | 30 HARRISON ST SUITE 320
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2161
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Country | US
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Telephone | 607-763-8205
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Fax | 607-763-8208
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTIAN DAHN TVETENSTRAND
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Credential | M.D.
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Telephone | 607-763-8205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 011154
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 178438
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License Number State | NY
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