Provider Demographics
NPI:1093797227
Name:DOLAN, PATTI (MD)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:DOLAN
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 1:6706 16TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-9050
Mailing Address - Country:US
Mailing Address - Phone:727-580-5176
Mailing Address - Fax:
Practice Address - Street 1:6706 16TH AVE E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-9050
Practice Address - Country:US
Practice Address - Phone:727-580-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 79926207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258556100Medicaid
FL49816OtherBLUE CROSS / BLUE SHIELD
FL1168350001Medicare NSC
FL49816OtherBLUE CROSS / BLUE SHIELD
FL49816ZMedicare PIN
F29219Medicare UPIN