Provider Demographics
NPI:1083134753
Name:DOLEZAL, DARIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:DOLEZAL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PEARL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3811
Mailing Address - Country:US
Mailing Address - Phone:516-578-8902
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH FRONTAGE ROAD
Practice Address - Street 2:EP2 2ND FLOOR - 612, DEPT OF PATHOLOGY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:516-578-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program