Healthcare Provider Details

I. General information

NPI: 1609739309
Provider Name (Legal Business Name): VIRGINIA CARROLL DORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINIA C. DORAN LAC

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 ROUTE 212 # 547 #547
BEARSVILLE NY
12409-5224
US

IV. Provider business mailing address

3203 ROUTE 212 # 547
BEARSVILLE NY
12409-5224
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-3265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: