Provider Demographics
NPI:1912186701
Name:DOLAN, BEVIN LASHLEY (MD)
Entity type:Individual
Prefix:
First Name:BEVIN
Middle Name:LASHLEY
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST 556
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-0210
Mailing Address - Fax:610-896-5101
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MOB EAST 556
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-0210
Practice Address - Fax:610-896-5101
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT182645207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002024432OtherHIGHMARK BLUE SHIELD
PA1021146200001Medicaid
3502778000OtherINDEPENDENCE BLUE CROSS
125188FA3Medicare PIN