Provider Demographics
NPI:1346349834
Name:DOLICH, BARRY HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:HOWARD
Last Name:DOLICH
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 1:63 CLUB POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4466
Mailing Address - Country:US
Mailing Address - Phone:914-686-0468
Mailing Address - Fax:718-828-1960
Practice Address - Street 1:1200 WATERS PLACE
Practice Address - Street 2:SUITE M106
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-430-0942
Practice Address - Fax:718-828-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100185208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B16515Medicare UPIN
562102Medicare ID - Type Unspecified