Provider Demographics
NPI:1780634824
Name:DOLAN, LUKE ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:ANTHONY
Last Name:DOLAN
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:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-963-8002
Mailing Address - Fax:864-963-2742
Practice Address - Street 1:DOCTOR'S FAMILY MEDICINE
Practice Address - Street 2:3115-D BRUSHY CREEK RD.
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-0903
Practice Address - Country:US
Practice Address - Phone:864-877-4221
Practice Address - Fax:877-379-3003
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC247842Medicaid
SCP01089179OtherRAILROAD MEDICARE
SCP01089179OtherRAILROAD MEDICARE
SCAA90997951Medicare PIN
H18687Medicare UPIN
H18687Medicare UPIN