MEDICARE: DR. SUSAN M. DASHOW 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	207L00000X	Anesthesiology Physician	OS008234L	PA
2	207L00000X	Anesthesiology Physician	25MB05618600	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050071448	OTHER	NJ	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2K2874	OTHER	NJ	HEALTH NET
3	0507477000	OTHER	NJ	AMERIHEALTH PRODUCTS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740277169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M. DASHOW DO

Provider Business Mailing Address
First Line	:	111 S 11TH ST STE 8490
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-6161
Fax Number	:	215-923-5507

Provider Business Practice Location Address
First Line	:	111 S 11TH ST STE 8490
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-6161
Fax Number	:	215-923-5507

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	01/15/2019

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Directions to “ DR. SUSAN M. DASHOW DO” Practice Location

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