Provider Demographics
NPI:1225011612
Name:NDOLO, JOSEPH N M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:N M
Last Name:NDOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1905
Mailing Address - Country:US
Mailing Address - Phone:251-929-0500
Mailing Address - Fax:251-929-0501
Practice Address - Street 1:310 S GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1905
Practice Address - Country:US
Practice Address - Phone:251-929-0500
Practice Address - Fax:251-929-0501
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21199174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51509057NDOOtherBLUE CROSS BLUE SHIELD
051509057Medicare PIN
G57068Medicare UPIN