Provider Demographics
NPI:1730235201
Name:MICHAEL J. DODD, M.D., PA
Entity type:Organization
Organization Name:MICHAEL J. DODD, M.D., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-2270
Mailing Address - Street 1:800 PRINCE FREDERICK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-5800
Mailing Address - Fax:410-535-5749
Practice Address - Street 1:800 PRINCE FREDERICK BOULEVARD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-5800
Practice Address - Fax:410-535-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX878MAOtherCAREFIRST BCBS
MD0968390001OtherGHMSI
MD0968390001Medicare NSC