Individual provider Active NPI

Pablo Aballe Dublin Jr., MD

  • Pediatrics Physician
  • Waldorf, MD
National Provider Identifier
1972675643
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D17859 Issued in MD
Practice address
11325 Pembroke Square
Suite 113
Waldorf, MD 20603-4807
Phone
(301) 645-1781
Fax
(301) 374-9237
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D17859 MD Primary

Addresses

Primary practice location

11325 Pembroke Square
Suite 113
Waldorf, MD 20603-4807

Mailing address

11325 Pembroke Square
Suite 113
Waldorf, MD 20603-4807
Phone (301) 645-1781

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D17859MDMDPediatrics Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972675643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11325 PEMBROKE SQUARE",
            "address_2": "SUITE 113",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034807",
            "telephone_number": "301-645-1781",
            "fax_number": "301-374-9237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 PEMBROKE SQUARE",
            "address_2": "SUITE 113",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034807",
            "telephone_number": "301-645-1781",
            "fax_number": "301-374-9237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBLIN",
        "first_name": "PABLO",
        "middle_name": "ABALLE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D17859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.