Provider Demographics
NPI:1588947097
Name:DOLAN, ASHLEY MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5430 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2224
Mailing Address - Country:US
Mailing Address - Phone:304-925-3627
Mailing Address - Fax:304-925-1163
Practice Address - Street 1:5430 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2224
Practice Address - Country:US
Practice Address - Phone:304-925-3627
Practice Address - Fax:304-925-1163
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01531363AM0700X
WV630363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical