Basic Information
Provider Information
NPI: 1922329796
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOBKIN
FirstName: ERIC
MiddleName: DAVID
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8500-6355
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191780001
CountryCode: US
TelephoneNumber: 6104977520
FaxNumber: 6104977525
Practice Location
Address1: 100 W SPROUL RD
Address2:  
City: SPRINGFIELD
State: PA
PostalCode: 190642033
CountryCode: US
TelephoneNumber: 6103388243
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2010
LastUpdateDate: 06/16/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0102XMD430158PAY Allopathic & Osteopathic PhysiciansSurgerySurgical Critical Care

No ID Information.


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