Provider Demographics
NPI:1720123102
Name:DORGAN, VICTORIA S
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:DORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BALCOM ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 BALCOM ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2010
Practice Address - Country:US
Practice Address - Phone:508-261-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA702925OtherHARVARD PILGRIM HEALTH
MA804276OtherTUFTS SECURE HORIZON
MA376454OtherBLUE CROSS BLUE SHIELD MA
MA1537083Medicaid
MA82-09709OtherUNITED HEALTHCARE OF NE
MA804276OtherTUFTS SECURE HORIZON