Provider Demographics
NPI:1811244080
Name:WENDY E DORAN, MD PA
Entity type:Organization
Organization Name:WENDY E DORAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-620-2612
Mailing Address - Street 1:370 CAMINO GARDENS BLVD
Mailing Address - Street 2:204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5816
Mailing Address - Country:US
Mailing Address - Phone:561-620-2612
Mailing Address - Fax:561-620-2614
Practice Address - Street 1:370 CAMINO GARDENS BLVD
Practice Address - Street 2:204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5816
Practice Address - Country:US
Practice Address - Phone:561-620-2612
Practice Address - Fax:561-620-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 761962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty