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NPI Code Detail

MEDICARE: DR. ROBERT THOMAS DODGE PHD, RN, ANP

MEDICARE: DR. ROBERT THOMAS DODGE PHD, RN, ANP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner900106NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295721710
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT THOMAS DODGE PHD, RN, ANP
Provider Business Mailing Address
First Line : 10 SUNNYBROOK RD
Second Line : CLINIC A
City : RALEIGH
State : NC
Zip : 27610-1808
Country : US
Telephone Number : 919-250-3078
Fax Number : 919-250-4429
Provider Business Practice Location Address
First Line : 10 SUNNYBROOK RD
Second Line : CLINIC A
City : RALEIGH
State : NC
Zip : 27610-1808
Country : US
Telephone Number : 919-250-3078
Fax Number : 919-250-4429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 06/30/2010

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