1386969764 NPI number — MRS. LINDSEY BRODELL DOLOHANTY M.D.

Table of content: MRS. LINDSEY BRODELL DOLOHANTY M.D. (NPI 1386969764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386969764 NPI number — MRS. LINDSEY BRODELL DOLOHANTY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLOHANTY
Provider First Name:
LINDSEY
Provider Middle Name:
BRODELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRODELL
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386969764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 ELMWOOD AVE.
Provider Second Line Business Mailing Address:
BOX 697
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-275-7546
Provider Business Mailing Address Fax Number:
585-461-3509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 SOUTH AVE.
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-341-9530
Provider Business Practice Location Address Fax Number:
585-756-5111
Provider Enumeration Date:
03/29/2010

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: 207N00000X , with the licence number:  273896 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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