Provider Demographics
NPI:1831167683
Name:ANDREW S. DOBIN, MD PA
Entity type:Organization
Organization Name:ANDREW S. DOBIN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-741-4579
Mailing Address - Street 1:PO BOX 64720
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4720
Mailing Address - Country:US
Mailing Address - Phone:443-481-6566
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:4175 N HANSON CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3179
Practice Address - Country:US
Practice Address - Phone:301-464-9660
Practice Address - Fax:301-464-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D48ANOtherBCBS
5671OtherBCBS
MD400365900Medicaid
0D48ANOtherBCBS
5671OtherBCBS
MD400365900Medicaid