Healthcare Provider Details

I. General information

NPI: 1386670248
Provider Name (Legal Business Name): KELLEY MELISSA DODSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MARSHALL ST SUITE 401
RICHMOND VA
23219-2050
US

IV. Provider business mailing address

PO BOX 980146
RICHMOND VA
23298-0146
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-4368
  • Fax: 804-828-8299
Mailing address:
  • Phone: 804-828-2866
  • Fax: 804-828-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101237922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: