Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 79504 | MA |
NPI | 1194736017 |
---|---|
Provider Name | Dr. Janemarie N Dolan |
First Address | Brockton, MA 02301-4042 |
Second Address | Brockton, MA 02301-4042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 19/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0034435 | NHP (01) | MA |
1309927 | (05) | MA |
33101 | CMSP (01) | MA |
33101 | HEALTHY START (01) | MA |
F47908 | (02) | |
J14673 | BLUE CROSS BLUE SHIELD (01) | MA |