Provider Demographics
NPI:1093770661
Name:DOLOJAN, THERESITA M (MD)
Entity Type:Individual
Prefix:MISS
First Name:THERESITA
Middle Name:M
Last Name:DOLOJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1015
Mailing Address - Country:US
Mailing Address - Phone:585-786-5086
Mailing Address - Fax:
Practice Address - Street 1:408 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1015
Practice Address - Country:US
Practice Address - Phone:585-786-5086
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113387207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00632297Medicaid
NY00632297Medicaid
A52223Medicare ID - Type Unspecified