Healthcare Provider Details

I. General information

NPI: 1104528876
Provider Name (Legal Business Name): ELIZABETH ANN BEVERLY DODD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN BEVERLY MD

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7023 OLD JAHNKE RD
RICHMOND VA
23225-4126
US

IV. Provider business mailing address

7023 OLD JAHNKE RD
RICHMOND VA
23225-4126
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-1353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101288984
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: