=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114970480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON A DUBIN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 S WASHINGTON ST STE 12
-----------------------------------------------------
City | GETTYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17325-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-339-2875
-----------------------------------------------------
Fax | 717-334-3921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3421 CONCORD RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-9001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-339-2875
-----------------------------------------------------
Fax | 717-334-3921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | BD2074665
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | OS006991L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS006991L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------