Provider Demographics
NPI:1184619611
Name:DOLPHIN, ANGELA D (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:DOLPHIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1824
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1824
Mailing Address - Country:US
Mailing Address - Phone:319-369-4505
Mailing Address - Fax:319-369-4677
Practice Address - Street 1:1790 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2033
Practice Address - Country:US
Practice Address - Phone:319-378-8362
Practice Address - Fax:319-369-4505
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1460363AM0700X
IL085-001956363AM0700X
IA001460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA161801Medicare ID - Type UnspecifiedMEDICARE UGS
IAI8556Medicare ID - Type UnspecifiedIA MEDICARE PART B