Provider Demographics
NPI:1356300222
Name:DUBIN, JONATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:DUBIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:410-521-5600
Mailing Address - Fax:410-580-9061
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-521-5600
Practice Address - Fax:410-580-9061
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2015-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0040131207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E66170Medicare UPIN