Provider Demographics
NPI:1811086614
Name:DOLPH, JAMES LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:DOLPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-482-7874
Mailing Address - Fax:518-482-7987
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-482-7874
Practice Address - Fax:518-482-7987
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172323-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01048746Medicaid
NY040426005318OtherFIDELIS
NY19200OtherMVP
NY10000502OtherCDPHP
NY000405145001OtherBLUE SHIELD NENY
NY89E321OtherEMPIRE BCBS
A57789Medicare UPIN
NY000405145001OtherBLUE SHIELD NENY