Provider Demographics
NPI:1427049733
Name:DABRAL, SANJAY (MD)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:DABRAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 54TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1900
Mailing Address - Country:US
Mailing Address - Phone:215-748-9707
Mailing Address - Fax:610-748-9708
Practice Address - Street 1:1 W ELM ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2007
Practice Address - Country:US
Practice Address - Phone:610-567-6964
Practice Address - Fax:610-567-6170
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2323402000OtherKEYSTONE HEALTH PLAN EAST
PA30019522OtherKMHP
PA7277558OtherAETNA
PA101103440001Medicaid
PA1646447OtherBLUE SHIELD
PAP00153063Medicare PIN
PA30019522OtherKMHP