Provider Demographics
NPI:1942233093
Name:DOLAN, LINDA B (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
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 1:8900 SE 165TH MULBERRY LANE
Mailing Address - Street 2:THE VILLAGES VA OUTPATIENT CLINIC
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:352-674-5000
Mailing Address - Fax:352-674-5030
Practice Address - Street 1:8900 SE 165TH MULBERRY LN
Practice Address - Street 2:THE VILLAGES VA OUTPATIENT CLINIC
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5884
Practice Address - Country:US
Practice Address - Phone:352-674-5000
Practice Address - Fax:352-674-5030
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00591566EMedicaid
GA00591566EMedicaid
GA08BDMLSMedicare ID - Type UnspecifiedMEDICARE