Provider Demographics
NPI:1578690129
Name:SCHIVELY, DORA HAMMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:HAMMAR
Last Name:SCHIVELY
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 1:41 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:MILLERTON
Mailing Address - State:NY
Mailing Address - Zip Code:12546-4628
Mailing Address - Country:US
Mailing Address - Phone:518-789-9648
Mailing Address - Fax:518-789-9648
Practice Address - Street 1:1056 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0112
Practice Address - Country:US
Practice Address - Phone:212-831-1055
Practice Address - Fax:212-438-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104268204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine