1801857933 NPI number — MERRIEBETH DODGE DO

Table of content: MERRIEBETH DODGE DO (NPI 1801857933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801857933 NPI number — MERRIEBETH DODGE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODGE
Provider First Name:
MERRIEBETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801857933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1HOSPTAL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BLUFFS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02557-1477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-693-3164
Provider Business Mailing Address Fax Number:
508-696-5238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPTAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BLUFFS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02557-1477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-693-3164
Provider Business Practice Location Address Fax Number:
508-696-5238
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  220282 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 220282 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10083969 . This is a "CAPITAL PHYSICIANS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 469003 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00131174 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA19492 . This is a "HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J27382 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2072220 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6298964 . This is a "CIGNA INDEMNITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000028288 . This is a "HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 34098 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043531502 . This is a "GIC INDEMNITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 781262 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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