Provider Demographics
NPI:1306858055
Name:WOLLNEY, DANA ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ELLIOTT
Last Name:WOLLNEY
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 1:8821 COLUMBIA 100 PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2168
Mailing Address - Country:US
Mailing Address - Phone:410-997-0500
Mailing Address - Fax:410-730-8898
Practice Address - Street 1:8821 COLUMBIA 100 PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2168
Practice Address - Country:US
Practice Address - Phone:410-997-0500
Practice Address - Fax:410-730-8898
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00322862080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD430511601Medicaid
K007R217Medicare ID - Type Unspecified
MD430511601Medicaid