Provider Demographics
NPI:1396718342
Name:DOLAN, KATIE A (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:411 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4415
Mailing Address - Country:US
Mailing Address - Phone:775-770-7600
Mailing Address - Fax:775-770-7880
Practice Address - Street 1:8040 S VIRGINIA ST STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8939
Practice Address - Country:US
Practice Address - Phone:775-770-7480
Practice Address - Fax:775-770-7499
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016495Medicaid
11176803OtherCAQH
NV80124583OtherRAILROAD MEDICARE
NVG69316Medicare UPIN
NV002016495Medicaid