Healthcare Provider Details

I. General information

NPI: 1477575355
Provider Name (Legal Business Name): DENNIS KOLOKOLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 W CUMBERLAND RD
BLUEFIELD VA
24605-2005
US

IV. Provider business mailing address

1145 S UTICA AVE STE 460
TULSA OK
74104-4041
US

V. Phone/Fax

Practice location:
  • Phone: 276-326-1618
  • Fax: 276-326-1618
Mailing address:
  • Phone: 918-579-5749
  • Fax: 918-579-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number27434
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2022-0355
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101229030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: