Provider Demographics
NPI:1639110091
Name:DOBASH, GREGORY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:DOBASH
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 1:411 SHENANDOAH RD
Mailing Address - Street 2:
Mailing Address - City:RINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17967-9432
Mailing Address - Country:US
Mailing Address - Phone:570-889-3103
Mailing Address - Fax:570-889-3575
Practice Address - Street 1:411 SHENANDOAH RD
Practice Address - Street 2:
Practice Address - City:RINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:17967-9432
Practice Address - Country:US
Practice Address - Phone:570-889-3103
Practice Address - Fax:570-889-3575
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001950614Medicaid
PAH81874Medicare UPIN
PA001950614Medicaid