Healthcare Provider Details

I. General information

NPI: 1306858055
Provider Name (Legal Business Name): DANA ELLIOTT WOLLNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 COLUMBIA 100 PKWY
COLUMBIA MD
21045-2168
US

IV. Provider business mailing address

8821 COLUMBIA 100 PKWY
COLUMBIA MD
21045-2168
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-0500
  • Fax: 410-730-8898
Mailing address:
  • Phone: 410-997-0500
  • Fax: 410-730-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0032286
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: