Provider Demographics
NPI:1942279146
Name:DOLIN, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DOLIN
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 1:55 NYE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1281
Mailing Address - Country:US
Mailing Address - Phone:860-633-6634
Mailing Address - Fax:860-652-3291
Practice Address - Street 1:55 NYE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1281
Practice Address - Country:US
Practice Address - Phone:860-633-6634
Practice Address - Fax:860-652-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026368207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1263680Medicaid
CT180000343Medicare PIN
CTB39298Medicare UPIN