Provider Demographics
NPI:1275562720
Name:DAWSON, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3637 EVERSHOT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4487
Mailing Address - Country:US
Mailing Address - Phone:478-714-2970
Mailing Address - Fax:804-378-6721
Practice Address - Street 1:9900 W BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6512
Practice Address - Country:US
Practice Address - Phone:804-358-0361
Practice Address - Fax:804-358-4286
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043192207Q00000X
VA0101252765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000738295KMedicaid
GA08BBWLKMedicare PIN
GA000738295KMedicaid
P00170514Medicare PIN