Provider Demographics
NPI:1588625784
Name:DOLGAN, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DOLGAN
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:PO BOX 843298
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3298
Mailing Address - Country:US
Mailing Address - Phone:910-878-5100
Mailing Address - Fax:910-878-5140
Practice Address - Street 1:4565 FAYETTEVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7998
Practice Address - Country:US
Practice Address - Phone:910-878-5100
Practice Address - Fax:910-878-5100
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050777D207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459504Medicaid
OH0836435Medicare ID - Type Unspecified
OH0459504Medicaid