Provider Demographics
NPI:1366615304
Name:IEON L.O. DAWSON
Entity type:Organization
Organization Name:IEON L.O. DAWSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLINE
Authorized Official - Middle Name:PAMELLA
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-669-5821
Mailing Address - Street 1:1257 GERSTNER CT
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1935
Mailing Address - Country:US
Mailing Address - Phone:202-669-5821
Mailing Address - Fax:410-721-4488
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE B205
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1935
Practice Address - Country:US
Practice Address - Phone:202-669-5821
Practice Address - Fax:410-721-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017174700Medicaid
G01430I01Medicare PIN
G26606Medicare UPIN