Provider Demographics
NPI:1568554731
Name:DOLAN, GAIL (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
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 1:10492 BRISTOW CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2202
Mailing Address - Country:US
Mailing Address - Phone:571-379-4246
Mailing Address - Fax:571-379-4276
Practice Address - Street 1:10492 BRISTOW CENTER DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2202
Practice Address - Country:US
Practice Address - Phone:571-379-4246
Practice Address - Fax:571-379-4276
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010234434208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010025087Medicaid
VA010025087Medicaid
004470C51Medicare ID - Type Unspecified