Healthcare Provider Details

I. General information

NPI: 1265879084
Provider Name (Legal Business Name): EMILY C DODENHOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY C WALROTH M.D.

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE SOUTH CPPI 102 DIVISION OF PEDIATRIC CRITICAL CARE
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-3342
  • Fax: 205-975-6505
Mailing address:
  • Phone: 205-731-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number36868
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: