Provider Demographics
NPI:1598773426
Name:DOLAN, CAROLYN J (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:J
Last Name:DOLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:J
Other - Last Name:COMBIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:333 BRUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1000
Mailing Address - Country:US
Mailing Address - Phone:617-333-1120
Mailing Address - Fax:
Practice Address - Street 1:700 CONGRESS ST
Practice Address - Street 2:SUITE 301
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0909
Practice Address - Country:US
Practice Address - Phone:617-786-1455
Practice Address - Fax:617-786-1463
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100959363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354210Medicaid
MADO NP 3369Medicare ID - Type Unspecified