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Organization
TWIN RIVER UROLOGY
Active
Organization
TWIN RIVER UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY L DETZER (BUS MANAGER)
(802) 296-7370
Entity
Organization
Contact information
Practice address
108 NO MAIN ST, TWIN RIVER UROLOGY, WHITE RIVER JCT, VT 05001
(802) 296-7370
(802) 296-7174
Mailing address
108 NO MAIN ST, TWIN RIVER UROLOGY, WHITE RIVER JCT, VT 05001
(802) 296-7370
(802) 296-7174
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0420008456
VT
208800000X
Urology Physician
8746
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000301
MEDICARE GROUP
VT
05
—
OVN0573
—
VT
Enumeration date
08/21/2006
Last updated
07/17/2007
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