Provider Demographics
NPI:1578664538
Name:DOLAN, MELDA S (MD)
Entity type:Individual
Prefix:
First Name:MELDA
Middle Name:S
Last Name:DOLAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3691 RUTGER ST
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2515
Mailing Address - Country:US
Mailing Address - Phone:314-977-6828
Mailing Address - Fax:314-977-6777
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:14TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8890
Practice Address - Fax:314-268-5172
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO1999143039207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205094303Medicaid
MO205094303Medicaid
H23511Medicare UPIN