Provider Demographics
NPI:1386670248
Name:DODSON, KELLEY MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:MELISSA
Last Name:DODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 980146
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0146
Mailing Address - Country:US
Mailing Address - Phone:804-828-2866
Mailing Address - Fax:804-828-3495
Practice Address - Street 1:1201 E MARSHALL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2050
Practice Address - Country:US
Practice Address - Phone:804-628-4368
Practice Address - Fax:804-828-8299
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237922207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI38548Medicare UPIN
VA008255M91Medicare ID - Type Unspecified