Provider Demographics
NPI:1871654558
Name:DUBOW, SCOTT RYAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RYAN
Last Name:DUBOW
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 1:3401 CIVIC CENTER BLVD STE 9329
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:215-590-1858
Mailing Address - Fax:215-590-1415
Practice Address - Street 1:3401 CIVIC CENTER BLVD STE 9329
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1858
Practice Address - Fax:215-590-1415
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421925207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1582557POtherGATEWAY
PA1609880OtherHIGHMARK BLUE SHIELD
PA232040568OtherDEVON HEALTH PLAN
PA1011424240Medicaid
PA50085608OtherCAPITAL ADVANTAGE
PAP00735624OtherRAIL ROAD
NJ0065447Medicaid
PA2287511000OtherINDEPENDENCE BLUE CROSS
PA000000275213OtherUNISON
PA1011424240Medicaid