Provider Demographics
NPI:1306892393
Name:DALLDORF, CAROLYN J (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:J
Last Name:DALLDORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1490 PANTOPS MOUNTAIN PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4601
Mailing Address - Country:US
Mailing Address - Phone:434-979-4440
Mailing Address - Fax:
Practice Address - Street 1:1490 PANTOPS MOUNTAIN PL STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4601
Practice Address - Country:US
Practice Address - Phone:434-979-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2124921OtherMAMSI
VA45314OtherCOMMUNITY HEALTH
VA4939578OtherCIGNA
VA207908OtherSOUTHERN HEALTH
VA230701OtherANTHEM SVCS/HEALTHKEEPERS
VA230701OtherANTHEM SVCS/HEALTHKEEPERS
VA2124921OtherMAMSI
VA207908OtherSOUTHERN HEALTH