Provider Demographics
NPI:1124186028
Name:DODGE, KARIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:M
Last Name:DODGE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:8028 RITCHIE HIGHWAY
Practice Address - Street 2:SUITE 134
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-553-2400
Practice Address - Fax:410-553-2466
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-01-10
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Provider Licenses
StateLicense IDTaxonomies
MD044804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70972Medicare UPIN
K679H844Medicare ID - Type Unspecified