Provider Demographics
NPI:1184616450
Name:DUBOV, WAYNE E (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:E
Last Name:DUBOV
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1770 BATHGATE RD
Practice Address - Street 2:SUITE 402
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7334
Practice Address - Country:US
Practice Address - Phone:610-402-3560
Practice Address - Fax:610-402-3355
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046397L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA54646OtherGEISINGER
PA718347OtherBLUE SHIELD
PAF25139Medicare UPIN
PA3077206OtherAETNA
PA718347OtherKEYSTONE CENTRAL
PA821240OtherFIRST PRIORITY HEALTH
PAP2986567OtherOXFORD
PA0012774690005Medicaid
PA718347OtherAMERIHEALTH ADMIN
PA5007090OtherBLUE CROSS
PA718347Medicare PIN
PA250014267OtherRAILROAD MEDICARE
PA0505263004OtherCIGNA
PA0555272000OtherKEYSTONE EAST