Provider Demographics
NPI:1508835497
Name:DODOO, RAPHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:
Last Name:DODOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 CRAIN HIGHWAY
Mailing Address - Street 2:7
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-590-3424
Mailing Address - Fax:410-590-3425
Practice Address - Street 1:1916 CRAIN HIGHWAY
Practice Address - Street 2:7
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-590-3424
Practice Address - Fax:410-590-3425
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699525000Medicaid
MD089L 272KMedicare ID - Type Unspecified
MD699525000Medicaid