Provider Demographics
NPI:1992808927
Name:MIDDLEMAN, DORI (MD)
Entity type:Individual
Prefix:DR
First Name:DORI
Middle Name:
Last Name:MIDDLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1617
Mailing Address - Country:US
Mailing Address - Phone:610-664-7793
Mailing Address - Fax:610-664-6667
Practice Address - Street 1:300 E LANCASTER AVE
Practice Address - Street 2:WYNNEWOOD HOUSE, SUITE 306B
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2139
Practice Address - Country:US
Practice Address - Phone:610-664-7793
Practice Address - Fax:610-664-6667
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042136E2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001134591000Medicaid
PA001134591000Medicaid