Healthcare Provider Details

I. General information

NPI: 1841384096
Provider Name (Legal Business Name): L DOUGLAS DOLGOV MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 UNION ST
NATICK MA
01760-7700
US

IV. Provider business mailing address

PO BOX 2200
AMHERST NH
03031-4200
US

V. Phone/Fax

Practice location:
  • Phone: 508-650-9999
  • Fax: 508-653-1054
Mailing address:
  • Phone: 603-673-9411
  • Fax: 603-673-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: L. DOUGLAS DOLGOV
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 508-650-9999