Provider Demographics
NPI:1679651285
Name:DUBOSKY, KAREN F (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:F
Last Name:DUBOSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11450 BRICKSHIRE PARK
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-4415
Mailing Address - Country:US
Mailing Address - Phone:804-557-3548
Mailing Address - Fax:
Practice Address - Street 1:11450 BRICKSHIRE PARK
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-4415
Practice Address - Country:US
Practice Address - Phone:804-557-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101244623Medicaid
CA00G471650Medicaid
CA00G471650Medicaid
F25978Medicare UPIN