Provider Demographics
NPI:1609815836
Name:DAWSON, MARTIN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:SCOTT
Last Name:DAWSON
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 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:698 MULLICA HILL RD STE 330
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4453
Practice Address - Country:US
Practice Address - Phone:856-508-3707
Practice Address - Fax:856-221-4077
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06620600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1684507OtherAMERICHOICE
NJP1726454OtherOXFORD
PA035403POCOtherPENNSYLVANIA MEDICARE
NJ222173875OtherBLUE SHIELD
NJ8081808Medicaid
NJ30016940OtherKEYSTONE MERCY
NJ060054994OtherRAILROAD MEDICARE
NJ2183266OtherAETNA HMO
NJ0676793000OtherAMERIHEALTH
NJ1114375OtherHORIZON MERCY
NJ332697OtherAMERIHEALTH ADMINISTRATOR
0676793000OtherPENNSYLVANIA BLUE SHIELD
NJ8909748001OtherCIGNA
NJIK8242OtherHEALTHNET
0676793000OtherPENNSYLVANIA BLUE SHIELD
NJ023870BAGMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER