Provider Demographics
NPI:1548207319
Name:DOLAN, LYNDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:M
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3009
Mailing Address - Country:US
Mailing Address - Phone:808-933-9187
Mailing Address - Fax:808-961-5905
Practice Address - Street 1:409 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3009
Practice Address - Country:US
Practice Address - Phone:808-933-9187
Practice Address - Fax:808-961-5905
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00217901Medicaid
HI00A0212306OtherHMSA
HI00217901Medicaid
HI00A0212306OtherHMSA