Provider Demographics
NPI:1245310366
Name:DOLATA, WOJCIECH KAZIMIERZ (MD)
Entity type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:KAZIMIERZ
Last Name:DOLATA
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 1:801 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3147
Mailing Address - Country:US
Mailing Address - Phone:304-637-3640
Mailing Address - Fax:
Practice Address - Street 1:801 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3147
Practice Address - Country:US
Practice Address - Phone:304-637-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070546207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00353886OtherRAILROAD MEDICARE