Healthcare Provider Details

I. General information

NPI: 1093865784
Provider Name (Legal Business Name): WILLIAM G DOLENGO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10729 BIRMINGHAM WAY SUITE A
WOODSTOCK MD
21163-1403
US

IV. Provider business mailing address

10729 BIRMINGHAM WAY SUITE A
WOODSTOCK MD
21163-1403
US

V. Phone/Fax

Practice location:
  • Phone: 410-461-0080
  • Fax: 410-461-8566
Mailing address:
  • Phone: 410-461-0080
  • Fax: 410-461-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01969
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: