Provider Demographics
NPI:1093781080
Name:DUBARTELL, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:DUBARTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:515 JERSEYTOWN RD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:PA
Practice Address - Zip Code:17846-8825
Practice Address - Country:US
Practice Address - Phone:570-458-5597
Practice Address - Fax:570-458-5114
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD057607L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001689800Medicaid
PA263778Medicare ID - Type Unspecified