Provider Demographics
NPI:1447228580
Name:DODD, SUSAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:P
Last Name:DODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9314 PARKWEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4338
Mailing Address - Country:US
Mailing Address - Phone:865-690-7677
Mailing Address - Fax:865-690-7627
Practice Address - Street 1:9314 PARKWEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4338
Practice Address - Country:US
Practice Address - Phone:865-690-7677
Practice Address - Fax:865-690-7627
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN15635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3026595Medicaid
TN3026595Medicaid
TN3026590Medicare PIN
TN3373353Medicare PIN