Provider Demographics
NPI:1144220161
Name:DUBISKY, GARY JR (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DUBISKY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7489
Mailing Address - Country:US
Mailing Address - Phone:704-671-4080
Mailing Address - Fax:855-827-3282
Practice Address - Street 1:1061 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7489
Practice Address - Country:US
Practice Address - Phone:704-671-4080
Practice Address - Fax:855-827-3282
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-000182084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144220161Medicaid
MI4198046Medicaid
NC5906656Medicaid
SCN00018Medicaid
NC2576631Medicare PIN
MI4198046Medicaid
NCNCV141AMedicare PIN