Provider Demographics
NPI:1487758900
Name:DAWSON, MATTHEW SHANE (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SHANE
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:111 E 75TH ST OFC 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2816
Mailing Address - Country:US
Mailing Address - Phone:212-744-1100
Mailing Address - Fax:877-732-3203
Practice Address - Street 1:111 E 75TH ST OFC 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2816
Practice Address - Country:US
Practice Address - Phone:212-744-1100
Practice Address - Fax:646-688-5125
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225166208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY225166OtherLIC
BD7909875OtherDEA
NY105461Medicare UPIN