1942231568 NPI number — JAMES H DOLAN DPM

Table of content: JAMES H DOLAN DPM (NPI 1942231568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942231568 NPI number — JAMES H DOLAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLAN
Provider First Name:
JAMES
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1942231568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 PORTSMOUTH AVENUE, SUITE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03885-3212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-580-4440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 PORTSMOUTH AVE
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
STRATHAM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03885-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-658-0190
Provider Business Practice Location Address Fax Number:
603-658-0196
Provider Enumeration Date:
07/05/2006

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: 213EP1101X , with the licence number:  0221 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 0221 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 0221 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30006211 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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