1093865784 NPI number — DR. WILLIAM G DOLENGO D.C.

Table of content: DR. WILLIAM G DOLENGO D.C. (NPI 1093865784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093865784 NPI number — DR. WILLIAM G DOLENGO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLENGO
Provider First Name:
WILLIAM
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093865784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10729 BIRMINGHAM WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21163-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-461-0080
Provider Business Mailing Address Fax Number:
410-461-8566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10729 BIRMINGHAM WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21163-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-461-0080
Provider Business Practice Location Address Fax Number:
410-461-8566
Provider Enumeration Date:
01/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01969 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1626689 . This is a "UHC ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N162-0001 . This is a "BCBS REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 620634-02 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4114301 . This is a "MAMSI ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1077382 . This is a "AETNA ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".