Provider Demographics
NPI:1942591607
Name:OLGA DOROFTEI MD PA
Entity Type:Organization
Organization Name:OLGA DOROFTEI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOROFTEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-534-1127
Mailing Address - Street 1:1701 W NORTHWEST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8145
Mailing Address - Country:US
Mailing Address - Phone:817-284-9850
Mailing Address - Fax:
Practice Address - Street 1:3511 CORINTH PKWY
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208
Practice Address - Country:US
Practice Address - Phone:940-270-3400
Practice Address - Fax:940-270-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6265208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130918Medicare PIN