Basic Information
| Provider Information | |||||||||
| NPI: | 1649216292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOBBERTIN | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D.,D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 83 | ||||||||
| Address2: | |||||||||
| City: | LYNDONVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027489501 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NVRH CORNER MEDICAL | ||||||||
| Address2: | 195 INDUSTRIAL PKWY | ||||||||
| City: | LYNDON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027489501 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 042-0010008 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0009152 | 05 | VT | MEDICAID |