Healthcare Provider Details

I. General information

NPI: 1891875373
Provider Name (Legal Business Name): SIOBHAN M DOLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BROADWAY
BROOKLYN NY
11206-5318
US

IV. Provider business mailing address

815 BROADWAY
BROOKLYN NY
11206-5318
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-2030
  • Fax: 203-276-7908
Mailing address:
  • Phone: 646-614-8200
  • Fax: 646-614-8386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number198559
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number198559
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: