# TWIN RIVER UROLOGY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205941879
- **Authorized official:** MS. KATHY L DETZER (BUS MANAGER)
- **Authorized official phone:** (802) 296-7370

## Contact information

- **Practice address:** 108 NO MAIN ST, TWIN RIVER UROLOGY, WHITE RIVER JCT, VT 05001
- **Practice address phone:** (802) 296-7370
- **Practice address fax:** (802) 296-7174
- **Mailing address:** 108 NO MAIN ST, TWIN RIVER UROLOGY, WHITE RIVER JCT, VT 05001
- **Mailing address phone:** (802) 296-7370
- **Mailing address fax:** (802) 296-7174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 0420008456 | VT | Yes |
| 208800000X | Urology Physician | 8746 | NH | — |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 07/17/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000301 | MEDICARE GROUP | VT |
| 05 | — | OVN0573 | — | VT |