MEDICARE: JOHN DAWSEY MD

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	2085R0204X	Vascular & Interventional Radiology Physician	MD038547E	PA
2	2085R0202X	Diagnostic Radiology Physician	MD038547E	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
2	1423GR	OTHER	PA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912993668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAWSEY MD

Provider Business Mailing Address
First Line	:	517 PIERCE ST
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-5731
Country	:	US
Telephone Number	:	570-714-7226
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 PIERCE ST
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-5731
Country	:	US
Telephone Number	:	570-714-7226
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	01/05/2024

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Directions to “ JOHN DAWSEY MD” Practice Location

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