1346272820 NPI number — DRS. DOLGIN, DONNELLY, DAVIS & ASSOCIATES PA

Table of content: (NPI 1346272820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346272820 NPI number — DRS. DOLGIN, DONNELLY, DAVIS & ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. DOLGIN, DONNELLY, DAVIS & ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1346272820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4714 N ARMENIA AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33603-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-872-8794
Provider Business Mailing Address Fax Number:
813-879-1652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4714 N ARMENIA AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33603-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-872-8794
Provider Business Practice Location Address Fax Number:
813-879-1652
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOLGIN
Authorized Official First Name:
SANFORD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-872-8794

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0060810 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 251793100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261536300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251782500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000279100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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