Provider Demographics
NPI:1952326217
Name:DOLORESCO, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:DOLORESCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-288-3123
Mailing Address - Fax:804-288-6591
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-794-6400
Practice Address - Fax:804-897-0910
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3161423OtherAETNA
VA1848343OtherCIGNA
VAP00019576OtherRAILROAD MEDICARE
VA210024OtherSOUTHERN HEALTH
VA569703Medicaid
VA386554OtherANTHEM
569703OtherUNITED HEALTHCARE
VA3161423OtherAETNA
VAF67303Medicare UPIN