Provider Demographics
NPI:1659669554
Name:LEARSY, DAWN IDA (MD)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:IDA
Last Name:LEARSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:I
Other - Last Name:LEARSY-CAHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:109 E. 38TH ST. STE 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:646-912-9074
Mailing Address - Fax:646-912-9203
Practice Address - Street 1:109 E. 38TH ST. STE 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:646-912-9074
Practice Address - Fax:646-912-9203
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041979208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236130Medicaid