Provider Demographics
NPI:1114241676
Name:DORLAND, NATALIA SEMENOVNA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:SEMENOVNA
Last Name:DORLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:SEMENOVNA
Other - Last Name:KHOLYAVINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9645 GROVE CIR N STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4466
Mailing Address - Country:US
Mailing Address - Phone:763-302-4114
Mailing Address - Fax:763-302-4081
Practice Address - Street 1:9645 GROVE CIR N STE 100
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4466
Practice Address - Country:US
Practice Address - Phone:763-302-4114
Practice Address - Fax:763-302-4081
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN593722084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1114241676Medicaid