Provider Demographics
NPI:1578593273
Name:ODIE, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ODIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9106 PHILADELPHIA ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4329
Mailing Address - Country:US
Mailing Address - Phone:410-780-1980
Mailing Address - Fax:410-780-1984
Practice Address - Street 1:9106 PHILADELPHIA ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4329
Practice Address - Country:US
Practice Address - Phone:410-780-1980
Practice Address - Fax:410-780-1984
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0055306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7944212OtherAETNA PPO
MD012403600OtherMEDICAL ASSISTANCE
MD013868OtherJOHNS HOPKINS HEALTHCARE
MD0P94DH 61009606OtherCAREFIRST
MD537ROtherMEDICARE
H34457OtherMEDICARE UPIN
MD0404280OtherUNITED HEALTH CARE
MD013868OtherPRIORITY PARTNERS
MD013868OtherEMPLOYERS HEALTH PLAN
673115OtherNCPPO
MD7396509OtherMAMSI
MD0P94DH 61009605OtherCAREFIRST
GA110221459OtherRAILROAD MEDICARE
MD21D1019527OtherCLIA NUMBER
2579562OtherAETNA HMO
DCS206 0001OtherCAREFIRST