Individual
DOROTHY B. LOLLATHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1400 HIGHLAND RD STE 1, RICHMOND, IN 47374-8810
(765) 935-8905
(765) 939-4200
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICE, RICHMOND, IN 47374-1157
(765) 935-8905
(765) 939-4200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003160A
IN
363A00000X
Physician Assistant
50.002298RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000175652
ANTHEM BCBS
—
01
—
000000181581
UNISON MEDICAID
OH
01
—
001769308
MOUNTAIN STATE BCBS
—
05
—
0075679
—
OH
01
—
0498377
MOLINA MEDICAID
OH
05
—
1068920
—
WV
01
—
293560617
TRI CARE
OH
01
—
P00278526
RR MEDICARE
—
Enumeration date
07/04/2006
Last updated
05/17/2021
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