Healthcare Provider Details

I. General information

NPI: 1750601175
Provider Name (Legal Business Name): DARREN ROBERT DOLLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 01/07/2022
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LAWN AVE STE 100
ELKHART IN
46514-2493
US

IV. Provider business mailing address

710 N NILES AVE
SOUTH BEND IN
46617-1924
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-2893
  • Fax: 574-293-1298
Mailing address:
  • Phone: 574-647-1610
  • Fax: 574-237-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01074203A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: