Healthcare Provider Details

I. General information

NPI: 1104881770
Provider Name (Legal Business Name): WARSAW OB GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 NORTH MAIN ST
WARSAW NY
14569
US

IV. Provider business mailing address

408 NORTH MAIN ST
WARSAW NY
14569
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2219
  • Fax: 585-786-8977
Mailing address:
  • Phone: 585-786-2219
  • Fax: 585-786-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS THERESITA M DOLOJAN
Title or Position: PRESIDENT
Credential: MD
Phone: 585-786-2219