Provider Demographics
NPI:1417113515
Name:M. RANDY DALBOW,M.D.,P.C.
Entity Type:Organization
Organization Name:M. RANDY DALBOW,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:DALBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-935-9696
Mailing Address - Street 1:2000 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7611
Mailing Address - Country:US
Mailing Address - Phone:724-935-9696
Mailing Address - Fax:724-935-8190
Practice Address - Street 1:2000 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7611
Practice Address - Country:US
Practice Address - Phone:724-935-9696
Practice Address - Fax:724-935-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041841-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA616532OtherBLUE SHEILD