1801914353 NPI number — DR. MAUREEN DIANE DOLLINGER MD

Table of content: DR. ANDREW DUNLEVY DMD (NPI 1134485782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801914353 NPI number — DR. MAUREEN DIANE DOLLINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLLINGER
Provider First Name:
MAUREEN
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1801914353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 SHEPHERDS VINEYARD DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27502-6440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-303-1231
Provider Business Mailing Address Fax Number:
919-303-7989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 SHEPHERDS VINEYARD DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-6440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-303-1231
Provider Business Practice Location Address Fax Number:
919-303-7989
Provider Enumeration Date:
03/26/2007

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: 207Q00000X , with the licence number:  30326 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28811 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8928811 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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