Healthcare Provider Details

I. General information

NPI: 1366575599
Provider Name (Legal Business Name): DOTSON & HODGE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE SUITE 220
WASHINGTON DC
20003-4318
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE SUITE 220
WASHINGTON DC
20003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-2664
  • Fax: 202-546-3244
Mailing address:
  • Phone: 202-543-2664
  • Fax: 202-546-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18133
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17053
License Number StateDC

VIII. Authorized Official

Name: DR. SAMUEL C DOTSON III
Title or Position: PARTNER
Credential: M.D.
Phone: 202-543-2664