Provider Demographics
NPI:1003961574
Name:DODARD, MARTHEL PIERRE-ANTOINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHEL
Middle Name:PIERRE-ANTOINE
Last Name:DODARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PIERRE
Other - Middle Name:
Other - Last Name:DODARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:58 SUGAR MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1632
Mailing Address - Country:US
Mailing Address - Phone:516-674-3907
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153028146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65D091Medicare ID - Type Unspecified