Provider Demographics
NPI:1922763051
Name:BLUERIDGE CLINIC PLLC
Entity Type:Organization
Organization Name:BLUERIDGE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLGANIUC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:681-238-3115
Mailing Address - Street 1:PO BOX 1882
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1882
Mailing Address - Country:US
Mailing Address - Phone:681-207-5089
Mailing Address - Fax:681-207-5090
Practice Address - Street 1:818 N EISENHOWER DR STE B
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3112
Practice Address - Country:US
Practice Address - Phone:681-238-3115
Practice Address - Fax:681-238-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty