Healthcare Provider Details

I. General information

NPI: 1912993668
Provider Name (Legal Business Name): JOHN DAWSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 PIERCE ST
KINGSTON PA
18704-5731
US

IV. Provider business mailing address

517 PIERCE ST
KINGSTON PA
18704-5731
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-7226
  • Fax:
Mailing address:
  • Phone: 570-714-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD038547E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD038547E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: