Healthcare Provider Details

I. General information

NPI: 1205923232
Provider Name (Legal Business Name): NEAL T. SMITH & JEANNINE L. DOLAN, M.D.'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5973 WALWORTH ROAD
ONTARIO NY
14519
US

IV. Provider business mailing address

P.O. BOX 368
ONTARIO NY
14519
US

V. Phone/Fax

Practice location:
  • Phone: 315-524-2881
  • Fax: 315-524-2231
Mailing address:
  • Phone: 315-524-2881
  • Fax: 315-524-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEAL T. SMITH
Title or Position: PARTNER
Credential: M.D.
Phone: 315-524-2881