Healthcare Provider Details

I. General information

NPI: 1679009567
Provider Name (Legal Business Name): SARAH J DOLAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SYCAMORE ST STE 1
GLASTONBURY CT
06033-4508
US

IV. Provider business mailing address

114 WOODLAND ST DEPARTMENT OF SURGERY
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-430-4387
  • Fax:
Mailing address:
  • Phone: 860-714-5237
  • Fax: 860-714-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3879
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: