Basic Information
| Provider Information | |||||||||
| NPI: | 1871654558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUBOW | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 CIVIC CENTER BLVD STE 9329 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901858 | ||||||||
| FaxNumber: | 2155901415 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 CIVIC CENTER BLVD STE 9329 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901858 | ||||||||
| FaxNumber: | 2155901415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD421925 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | MD421925 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000000275213 | 01 | PA | UNISON | OTHER | P00735624 | 01 | PA | RAIL ROAD | OTHER | 1609880 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 232040568 | 01 | PA | DEVON HEALTH PLAN | OTHER | 50085608 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 0065447 | 05 | NJ | MEDICAID | 1582557P | 01 | GATEWAY | OTHER | 2287511000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 1011424240 | 05 | PA | MEDICAID |