Healthcare Provider Details

I. General information

NPI: 1205396959
Provider Name (Legal Business Name): LAUREN DUBNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3535 MARKET ST STE 200
PHILADELPHIA PA
19104-3377
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7119
  • Fax: 215-662-7200
Mailing address:
  • Phone: 215-746-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD474553
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: