Provider Demographics
NPI:1235114133
Name:DOVBERG, NORMAN JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JOSEPH
Last Name:DOVBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 KENWOOD AVE
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0730
Mailing Address - Country:US
Mailing Address - Phone:518-439-1907
Mailing Address - Fax:
Practice Address - Street 1:834 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9601
Practice Address - Country:US
Practice Address - Phone:518-439-1907
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1166742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B81758Medicare UPIN
37733BMedicare ID - Type Unspecified