Provider Demographics
NPI:1235758780
Name:DOTOLO, NIKOLAS
Entity Type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:
Last Name:DOTOLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GALE LN APT 123
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3019
Mailing Address - Country:US
Mailing Address - Phone:978-854-2905
Mailing Address - Fax:
Practice Address - Street 1:1900 BELMONT BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3757
Practice Address - Country:US
Practice Address - Phone:615-460-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program