Provider Demographics
NPI:1487686622
Name:DICKINSON, JOHN CARLTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARLTON
Last Name:DICKINSON
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 1:2 RUBIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544
Mailing Address - Country:US
Mailing Address - Phone:585-554-4400
Mailing Address - Fax:585-554-3342
Practice Address - Street 1:2 RUBIN DRIVE
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544
Practice Address - Country:US
Practice Address - Phone:585-554-4400
Practice Address - Fax:585-554-3342
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00618199Medicaid
NYRA8737Medicare PIN
NYC64687Medicare UPIN
NYN70206Medicare PIN