Provider Demographics
NPI:1972254928
Name:DOLAN, JOHANNA M
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:M
Last Name:DOLAN
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:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-0383
Mailing Address - Country:US
Mailing Address - Phone:301-241-3040
Mailing Address - Fax:
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE STE 215
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8365
Practice Address - Country:US
Practice Address - Phone:301-241-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor