Provider Demographics
NPI:1366507766
Name:DOLL, NICHOLAS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:DOLL
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 1:2645 ONEAL LN
Mailing Address - Street 2:BLDG D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3179
Mailing Address - Country:US
Mailing Address - Phone:225-926-7200
Mailing Address - Fax:225-706-2182
Practice Address - Street 1:2645 ONEAL LN
Practice Address - Street 2:BLDG D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3179
Practice Address - Country:US
Practice Address - Phone:225-926-7200
Practice Address - Fax:225-706-2182
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04414R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1193364Medicaid
LA1193364Medicaid
5K290Medicare ID - Type Unspecified