Provider Demographics
NPI:1013019272
Name:DOTSON, RICHARD LARRY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LARRY
Last Name:DOTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 BENNING RD NE
Mailing Address - Street 2:#102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-396-8200
Mailing Address - Fax:202-396-5023
Practice Address - Street 1:1647 BENNING RD NE
Practice Address - Street 2:#102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-396-8200
Practice Address - Fax:202-396-5023
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 11766208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023609300Medicaid
DC023609300Medicaid
408933G48Medicare ID - Type Unspecified