Provider Demographics
NPI:1750394979
Name:DOOLEY, RICHARD HARRY (PAC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:HARRY
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-878-8131
Mailing Address - Fax:802-879-6853
Practice Address - Street 1:586 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:802-879-6853
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S50624Medicare UPIN