Provider Demographics
NPI:1427049766
Name:DOLLARD, MARK D (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:DOLLARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:46440 BENEDICT DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-6602
Mailing Address - Country:US
Mailing Address - Phone:703-444-9555
Mailing Address - Fax:703-444-1190
Practice Address - Street 1:46440 BENEDICT DR
Practice Address - Street 2:SUITE 111
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:703-444-9555
Practice Address - Fax:703-444-1190
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103000649213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009302689Medicaid
VA48000120OtherPALMETTO GBA
VAT21611Medicare UPIN
VA4128120001Medicare NSC
VA458529F16Medicare ID - Type Unspecified