Provider Demographics
NPI:1962576694
Name:DOLAN, JAMES R (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:DOLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:321 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8655
Mailing Address - Country:US
Mailing Address - Phone:315-252-5679
Mailing Address - Fax:
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2333
Practice Address - Fax:315-452-2336
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175870207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418299Medicaid
NYJ400068145Medicare PIN