Provider Demographics
NPI:1093215394
Name:DAWSON, MICHELLE M (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 INGLESIDE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3224
Mailing Address - Country:US
Mailing Address - Phone:757-892-3270
Mailing Address - Fax:757-892-3265
Practice Address - Street 1:976 INGLESIDE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3224
Practice Address - Country:US
Practice Address - Phone:757-892-3270
Practice Address - Fax:757-892-3265
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$Medicaid