Provider Demographics
NPI:1235193624
Name:DOBSEVAGE, TINA (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:DOBSEVAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FIFTH AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0110
Mailing Address - Country:US
Mailing Address - Phone:646-672-0763
Mailing Address - Fax:646-672-0741
Practice Address - Street 1:1050 FIFTH AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0110
Practice Address - Country:US
Practice Address - Phone:646-672-0763
Practice Address - Fax:646-672-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13D201Medicare ID - Type Unspecified
B02559Medicare UPIN
W38581Medicare ID - Type Unspecified