Provider Demographics
NPI:1679581698
Name:DUBIN, NEIL S (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:DUBIN
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 1:58 EAST HOLLISTER STREET
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1704
Mailing Address - Country:US
Mailing Address - Phone:513-721-1737
Mailing Address - Fax:513-287-7465
Practice Address - Street 1:58 EAST HOLLISTER STREET
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1704
Practice Address - Country:US
Practice Address - Phone:513-721-1737
Practice Address - Fax:513-287-7465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350443802084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0438235Medicaid
000000067364OtherANTHEM
OH260050695OtherRAILROAD MEDICARE
OH024481000OtherMAGELLAN
KY64863483OtherKENTUCKY MEDICAID
OH311152004003OtherMEDICAL MUTUAL OF OHIO
OH1469300OtherUNITED MINE WORKERS
OH1469300OtherUNITED MINE WORKERS
OH260050695OtherRAILROAD MEDICARE