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NPI Code Detail

MEDICARE: KIMBERLY A DODD M.D.

MEDICARE:   KIMBERLY A DODD  M.D.
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician232516MA
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianMD13173RI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000137802OTHERRIMEDICARE PTAN

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 : 1366646820
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY A DODD M.D.
Provider Business Mailing Address
First Line : 111 BREWSTER STREET
Second Line :
City : PAWTUCKET
State : RI
Zip : 02860-4400
Country : US
Telephone Number : 401-729-3469
Fax Number : 401-729-2541
Provider Business Practice Location Address
First Line : 150 CHESTNUT ST STE 4
Second Line :
City : PROVIDENCE
State : RI
Zip : 02903-4649
Country : US
Telephone Number : 833-229-0957
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2007
Last Update Date : 04/10/2020

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Directions to “ KIMBERLY A DODD M.D.” Practice Location

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