Individual provider Active NPI

C Terrence Dolan, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Tulsa, OK
National Provider Identifier
1962429787
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
12544 Issued in OK
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

Updated by the provider on Oct 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
100258090BMedicaidOK
9791MedicaidOK
100158930AMedicaidKS

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

LicenseStateTypeSpecialty
10817NEMDPharmacist
04-13816KSMDAnatomic 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.

Verify at the official NPI Registry.