Provider Demographics
NPI:1396903266
Name:THOMAS E. DOOLEY, MD, PC
Entity type:Organization
Organization Name:THOMAS E. DOOLEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-924-2790
Mailing Address - Street 1:17904 GEORGIA AVE
Mailing Address - Street 2:SUITE #304
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2239
Mailing Address - Country:US
Mailing Address - Phone:301-924-2790
Mailing Address - Fax:301-924-1631
Practice Address - Street 1:17904 GEORGIA AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2239
Practice Address - Country:US
Practice Address - Phone:301-924-2790
Practice Address - Fax:301-924-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD875529OtherMAMSI
MD04528011OtherUNITED HEALTHCARE
MD9094 0001OtherFEDERAL BLUE SHIELD
4050595OtherAETNA/US HEALTHCARE
309640 01OtherBC/BS OF MARYLAND
MD9094 0001OtherFEDERAL BLUE SHIELD
MD========= 008OtherCIGNA
MD156792Medicare PIN