Dominick Peter Trivisonno, MD
Individual provider Active NPI General Practice Physician · Baker, MT
NPI 1235303801 · NPPES record last updated Jan 30, 2012
Key facts
- NPI
- 1235303801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 173465 (NY)
- Practice address
- 202 South 4TH Street West
Baker, MT 59313-1119 - Phone
- (406) 778-2833
- Fax
- (406) 778-5131
- NPI assigned
- Apr 15, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 173465 | NY | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 173465 | NY | Yes |
| General Practice Physician | 208D00000X | 11857 | MT |
Addresses
Primary practice location
202 South 4TH Street West
Baker, MT 59313-1119
Mailing address
PO Box 1119
Baker, MT 59313-1119
Phone (406) 778-2833
Other providers in Baker, MT
- Brian Michael Sullivan
- Superior Care Villa
- Victoria J Susa
- The Recovery Point Rehab, PLLC
- Taylee Rayne Tolzien
- Alyse Danielle Webber
All providers in Baker, MT · General Practice Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.