1265879084 NPI number — EMILY C DODENHOFF M.D.

Table of content: EMILY C DODENHOFF M.D. (NPI 1265879084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265879084 NPI number — EMILY C DODENHOFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODENHOFF
Provider First Name:
EMILY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALROTH
Provider Other First Name:
EMILY
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265879084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35255-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-731-9701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE SOUTH
Provider Second Line Business Practice Location Address:
CPPI 102 DIVISION OF PEDIATRIC CRITICAL CARE
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-638-3342
Provider Business Practice Location Address Fax Number:
205-975-6505
Provider Enumeration Date:
06/03/2013

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: 2080P0203X , with the licence number:  36868 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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