Provider Demographics
NPI:1053872622
Name:DUBNOW, MARA
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:DUBNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8860
Mailing Address - Country:US
Mailing Address - Phone:602-240-2401
Mailing Address - Fax:
Practice Address - Street 1:4747 N 7TH ST STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3677
Practice Address - Country:US
Practice Address - Phone:602-240-2401
Practice Address - Fax:602-792-0244
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125074455207V00000X
390200000X
AZ66170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program