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NPI Code Detail

MEDICARE: MS. MARY ELIZABETH DOLAN P.A.

MEDICARE: MS. MARY ELIZABETH DOLAN P.A.
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
1363AM0700XMedical Physician Assistant2005040394MO
2363A00000XPhysician Assistant2005040394MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12005040394OTHERMOP.A. LICENSE

General Provider Information

NPI Number : 1821013137
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ELIZABETH DOLAN P.A.
Provider Business Mailing Address
First Line : 6763 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 314-678-9857
Fax Number :
Provider Business Practice Location Address
First Line : 6763 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 314-678-9857
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 07/21/2022

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