Active NPI
Thomas Glennon Dorlac
- Specialist
- Wenatchee, WA
National Provider Identifier
1649585217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 60166075
- Practice address
- 620 N Emerson Ave
Wenatchee, WA 98801-6619 - Phone
- (509) 663-5420
- NPI assigned
- Aug 8, 2010
- Last updated
- Aug 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA 60166075 | WA | Primary |
Addresses
Primary practice location
620 N Emerson Ave
Wenatchee, WA 98801-6619
Mailing address
1023 W Park St
Wenatchee, WA 98801-3626
Phone (509) 387-1852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 60166075 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281225600000",
"number": "1649585217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1023 W PARK ST",
"city": "WENATCHEE",
"state": "WA",
"postal_code": "988013626",
"telephone_number": "509-387-1852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 N EMERSON AVE",
"city": "WENATCHEE",
"state": "WA",
"postal_code": "988016619",
"telephone_number": "509-663-5420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORLAC",
"first_name": "THOMAS",
"middle_name": "GLENNON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-08",
"last_updated": "2010-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA 60166075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wenatchee, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.