Healthcare Provider Details

I. General information

NPI: 1447203559
Provider Name (Legal Business Name): DENNIS M DOODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 NORTHWOODS BLVD
COLUMBUS OH
43235-4711
US

IV. Provider business mailing address

PO BOX 182255
COLUMBUS OH
43218-2255
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-4588
  • Fax:
Mailing address:
  • Phone: 614-430-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35037505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: