Provider Demographics
NPI:1356304513
Name:LIM, DAWSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWSON
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1013
Mailing Address - Country:US
Mailing Address - Phone:724-292-9404
Mailing Address - Fax:724-292-9218
Practice Address - Street 1:1163 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1013
Practice Address - Country:US
Practice Address - Phone:724-292-9404
Practice Address - Fax:724-292-9128
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019666E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014010OtherGATEWAY
PA170411Medicaid
PA421079OtherBLUE SHIELD
PA250760OtherUPMC
PA1014010OtherGATEWAY
C33798Medicare UPIN