1316931447 NPI number — JAMES E DODD II DPM

Table of content: JAMES E DODD II DPM (NPI 1316931447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316931447 NPI number — JAMES E DODD II DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODD
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1316931447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 N BRADDOCK ST
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-3969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-662-4572
Provider Business Mailing Address Fax Number:
540-722-9519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 N BRADDOCK ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-3969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-662-4572
Provider Business Practice Location Address Fax Number:
540-722-9519
Provider Enumeration Date:
09/03/2005

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: 213ES0103X , with the licence number:  0103000819 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CG4514 . This is a "MEDICARE ID TYPE UNSPECIF" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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