Provider Demographics
NPI:1093865784
Name:DOLENGO, WILLIAM G (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:DOLENGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10729 BIRMINGHAM WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1403
Mailing Address - Country:US
Mailing Address - Phone:410-461-0080
Mailing Address - Fax:410-461-8566
Practice Address - Street 1:10729 BIRMINGHAM WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1403
Practice Address - Country:US
Practice Address - Phone:410-461-0080
Practice Address - Fax:410-461-8566
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1626689OtherUHC ID
MDN162-0001OtherBCBS REGIONAL
MD620634-02OtherBCBS
MD4114301OtherMAMSI ID
MD1077382OtherAETNA ID
MD620634-02OtherBCBS
MD89175Medicare UPIN