MEDICARE: MICHAEL A DOLLARD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	006652	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080925000085	OTHER	NY	FIDELIS
2	6019908	OTHER	NY	MVP HEALTHCARE
3	10040637	OTHER	NY	CDPHP
4	000495200004	OTHER	NY	BSNENY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194788372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A DOLLARD PA

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD STE 203
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2461
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	1240 NEW SCOTLAND RD
Second Line	:	SUITE 203
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-9222
Country	:	US
Telephone Number	:	518-439-2460
Fax Number	:	518-439-3025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	01/25/2018

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Directions to “ MICHAEL A DOLLARD PA” Practice Location

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