Active NPI
C Terrence Dolan, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Tulsa, OK
National Provider Identifier
1962429787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 12544
- Practice address
- 4142 S Mingo Rd
Tulsa, OK 74146-3632 - Phone
- (918) 744-2553
- Fax
- (918) 744-3482
- NPI assigned
- Jul 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 12544 | OK | Primary |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 04-13816 | KS | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 10817 | NE | |
| Medical Microbiology Physician | 207ZM0300X | 12544 | OK |
Addresses
Primary practice location
4142 S Mingo Rd
Tulsa, OK 74146-3632
Mailing address
4142 S Mingo Rd
Tulsa, OK 74146-3632
Phone (918) 744-2553
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100258090B | Medicaid | OK | |
| 9791 | Medicaid | OK | |
| 100158930A | Medicaid | KS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10817 | NE | MD | Pharmacist |
| 04-13816 | KS | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1962429787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4142 S MINGO RD",
"city": "TULSA",
"state": "OK",
"postal_code": "741463632",
"telephone_number": "918-744-2553",
"fax_number": "918-744-3482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4142 S MINGO RD",
"city": "TULSA",
"state": "OK",
"postal_code": "741463632",
"telephone_number": "918-744-2553",
"fax_number": "918-744-3482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLAN",
"first_name": "C",
"middle_name": "TERRENCE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-16",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "OK",
"license": "12544",
"primary": true
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "KS",
"license": "04-13816",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NE",
"license": "10817",
"primary": false
},
{
"code": "207ZM0300X",
"taxonomy_group": "",
"desc": "Pathology, Medical Microbiology",
"state": "OK",
"license": "12544",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100258090B",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9791",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100158930A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.