Provider Demographics
NPI:1710417126
Name:DUBOVI, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DUBOVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 U P CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:RIMERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16248-4327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 SPORTSMAN DR STE 20
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8572
Practice Address - Country:US
Practice Address - Phone:914-223-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004132363A00000X
PAMA059012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant