Provider Demographics
NPI:1609815836
Name:DAWSON, MARTIN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:SCOTT
Last Name:DAWSON
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 1:1120 DELSEA DR N
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1444
Mailing Address - Country:US
Mailing Address - Phone:856-205-7070
Mailing Address - Fax:856-845-3760
Practice Address - Street 1:698 MULLICA HILL RD STE 330
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4453
Practice Address - Country:US
Practice Address - Phone:856-508-3707
Practice Address - Fax:856-221-4077
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060054994OtherRAILROAD MEDICARE
NJ30016940OtherKEYSTONE MERCY
NJ332697OtherAMERIHEALTH ADMINISTRATOR
NJ1684507OtherAMERICHOICE
NJ8909748001OtherCIGNA
NJ2183266OtherAETNA HMO
NJ1114375OtherHORIZON MERCY
NJ0676793000OtherAMERIHEALTH
0676793000OtherPENNSYLVANIA BLUE SHIELD
NJ8081808Medicaid
PA035403POCOtherPENNSYLVANIA MEDICARE
NJ222173875OtherBLUE SHIELD
NJP1726454OtherOXFORD
NJIK8242OtherHEALTHNET
0676793000OtherPENNSYLVANIA BLUE SHIELD
NJ023870BAGMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER