Provider Demographics
NPI:1346234648
Name:DOLCICH, AUGUSTINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:A
Last Name:DOLCICH
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:703-766-5047
Practice Address - Street 1:4080 LAFAYETTE CENTER DRIVE
Practice Address - Street 2:STE 170
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-766-5040
Practice Address - Fax:703-766-5047
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05624266Medicaid
080177774OtherRR MEDICARE
080177774OtherRR MEDICARE
VA00A428F32Medicare ID - Type Unspecified
F90304Medicare UPIN
VA05624266Medicaid
DEG00532Medicare PIN