Provider Demographics
NPI:1346272820
Name:DRS. DOLGIN, DONNELLY, DAVIS & ASSOCIATES PA
Entity Type:Organization
Organization Name:DRS. DOLGIN, DONNELLY, DAVIS & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOLGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-872-8794
Mailing Address - Street 1:4714 N ARMENIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2603
Mailing Address - Country:US
Mailing Address - Phone:813-872-8794
Mailing Address - Fax:813-879-1652
Practice Address - Street 1:4714 N ARMENIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2603
Practice Address - Country:US
Practice Address - Phone:813-872-8794
Practice Address - Fax:813-879-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251793100Medicaid
FL261536300Medicaid
FL251782500Medicaid
FLF02589Medicare UPIN
FL12998ZMedicare ID - Type UnspecifiedDOLGIN
FL251793100Medicaid
FLG05921Medicare UPIN
FLH39749Medicare UPIN
FL27163ZMedicare ID - Type UnspecifiedDONNELLY