Healthcare Provider Details

I. General information

NPI: 1780525303
Provider Name (Legal Business Name): AMERICAN INSTITUTE OF MODERN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 DRY HILL RD
BECKLEY WV
25801-2603
US

IV. Provider business mailing address

155 DRY HILL RD
BECKLEY WV
25801-2603
US

V. Phone/Fax

Practice location:
  • Phone: 681-238-3393
  • Fax: 563-220-4783
Mailing address:
  • Phone: 681-238-3393
  • Fax: 563-220-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1002X
TaxonomyPhysician Nutrition Specialist (Internal Medicine)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MD DOLGANIUC
Title or Position: MD
Credential: DOLGANIUC
Phone: 774-275-7575