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NPI Code Detail

MEDICARE: TERRY L. DODGE M.D.

MEDICARE: TERRY L. DODGE 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
1207L00000XAnesthesiology Physician6992SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2A9373OTHERMEDCOST

General Provider Information

NPI Number : 1639168339
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY L. DODGE M.D.
Provider Business Mailing Address
First Line : 1 MEDICAL PARK DR
Second Line :
City : CHESTER
State : SC
Zip : 29706-9769
Country : US
Telephone Number : 803-581-3151
Fax Number : 803-385-3183
Provider Business Practice Location Address
First Line : 1 MEDICAL PARK DR
Second Line :
City : CHESTER
State : SC
Zip : 29706-9769
Country : US
Telephone Number : 803-581-3151
Fax Number : 803-385-3183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 07/24/2007

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Directions to “ TERRY L. DODGE M.D.” Practice Location

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