Provider Demographics
NPI:1609858612
Name:DOLAN, DAMIAN FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:FRANCIS
Last Name:DOLAN
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 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 258
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:85 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-572-3232
Practice Address - Fax:859-572-3727
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060078D207L00000X
KY38010207L00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50019772OtherPASSPORT HEALTH
00000077646OtherANTHEM BLUE SHIELD
OH0790934Medicaid
KY64037930Medicaid
000000542722OtherANTHEM
IN200366080Medicaid
$$$$$$$$$00OtherBUREAU OF WORKERS COMP
KY64037930Medicaid
P00416442Medicare PIN
0918127Medicare PIN
00000077646OtherANTHEM BLUE SHIELD
OH0790934Medicaid
IN200366080Medicaid
$$$$$$$$$00OtherBUREAU OF WORKERS COMP