1457443566 NPI number — HOLLY DODD MPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457443566 NPI number — HOLLY DODD MPT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DODD

Provider First Name:

HOLLY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MPT

Provider Gender Code:

F

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:

1457443566

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

140 DAVIDSON LN

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EDINBURG

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22824-2617

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

540-984-4914

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

480 S COMMERCE AVE STE F

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FRONT ROYAL

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22630-3093

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

540-636-3500

Provider Business Practice Location Address Fax Number:

540-636-3502

Provider Enumeration Date:

09/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  2305202752 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 102809 . This is a "BCBS AQUATIC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 388826 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4576361 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 150718500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 194082 . This is a "BCBS GROUP # FR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 541966445 . This is a "UHC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 16040 . This is a "COMMUNITY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 142752 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 194085 . This is a "BCBS GROUP # WS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 541966445 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 194083 . This is a "BCBS GROUP # WI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 541966445 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".