Healthcare Provider Details

I. General information

NPI: 1467416800
Provider Name (Legal Business Name): JOHN DOLAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MARGINAL WAY STE 700
PORTLAND ME
04101-2481
US

IV. Provider business mailing address

100 GANNETT DR STE C
SOUTH PORTLAND ME
04106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-523-3900
  • Fax: 207-523-8593
Mailing address:
  • Phone: 207-828-0361
  • Fax: 207-874-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1635
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: