Provider Demographics
NPI:1740709138
Name:DOOLEY, TOMMY D II (PA-C)
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:D
Last Name:DOOLEY
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 U.S. RT. 60 E. SUITE 130
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-733-3333
Mailing Address - Fax:304-733-3666
Practice Address - Street 1:6007 U.S. RT. 60 E. SUITE 130
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-3333
Practice Address - Fax:304-733-3666
Is Sole Proprietor?:No
Enumeration Date:2017-09-17
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WV2108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD269029200Medicaid