MEDICARE: LARRY PAUL DOROSHOW DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DS005305L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396737805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY PAUL DOROSHOW DO

Provider Business Mailing Address
First Line	:	7131 RIDGE AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19128-3251
Country	:	US
Telephone Number	:	215-483-2113
Fax Number	:

Provider Business Practice Location Address
First Line	:	7131 RIDGE AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19128-3251
Country	:	US
Telephone Number	:	215-483-2113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/24/2012

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