Provider Demographics
NPI:1205059185
Name:DOLAN, PETER J (PA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:DOLAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PARK ST.
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-6441
Mailing Address - Fax:
Practice Address - Street 1:2077 LAKEVILLE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414
Practice Address - Country:US
Practice Address - Phone:585-226-4560
Practice Address - Fax:585-226-4565
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant