Provider Demographics
NPI:1851330922
Name:DWYER, DAWN T (MEDICAL PHYSICIAN AS)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:T
Last Name:DWYER
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Gender:F
Credentials:MEDICAL PHYSICIAN AS
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4165
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:PAOLI MEMORIAL MEDICAL BLDG #2
Practice Address - Street 2:255 W LANCASTER AVE SUITE 328
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-3902
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-11-26
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Provider Licenses
StateLicense IDTaxonomies
PAMA000734L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA249742GT6Medicare PIN