1871532549 NPI number — DR. KATHLEEN M DODSWORTH DPM

Table of content: DR. KATHLEEN M DODSWORTH DPM (NPI 1871532549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871532549 NPI number — DR. KATHLEEN M DODSWORTH DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODSWORTH
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1871532549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 E MONROE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-264-0110
Provider Business Mailing Address Fax Number:
585-264-9469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 E MONROE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-264-0110
Provider Business Practice Location Address Fax Number:
585-264-9469
Provider Enumeration Date:
06/06/2006

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: 213E00000X , with the licence number:  N0045471 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: P02331 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MD469M . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480011961 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010004547 . This is a "EXCELLUS" identifier . This identifiers is of the category "OTHER".