Provider Demographics
NPI:1386625895
Name:DOOLEY, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:DOOLEY
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 1:500 CUMMINGS CTR
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6142
Mailing Address - Country:US
Mailing Address - Phone:978-232-3555
Mailing Address - Fax:
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:SUITE 1650
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6142
Practice Address - Country:US
Practice Address - Phone:978-232-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1523762086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0195570Medicaid
H62050Medicare UPIN
A34031Medicare PIN