MEDICARE: DWAYNE E. ROLLINS, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	222755	NY

General Provider Information

NPI Number	:	1033234828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DWAYNE E. ROLLINS, MD, PC

Provider Business Mailing Address
First Line	:	12042 231ST ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-2220
Country	:	US
Telephone Number	:	718-978-5447
Fax Number	:	718-978-8752

Provider Business Practice Location Address
First Line	:	18718 LINDEN BLVD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-4026
Country	:	US
Telephone Number	:	718-978-5447
Fax Number	:	718-978-8752

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DWAYNE ERIC ROLLINS
Credential	:	M.D.
Telephone Number	:	718-978-5447

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	01/06/2016

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