Provider Demographics
NPI:1639187875
Name:MICHAEL J. DODD, M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL J. DODD, M.D., P.A.
Other - Org Name:MARYLAND EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-2270
Mailing Address - Street 1:800 PRINCE FREDERICK BLVD.
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-2270
Mailing Address - Fax:410-535-5749
Practice Address - Street 1:800 PRINCE FREDERICK BLVD.
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-2270
Practice Address - Fax:410-535-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCC0607OtherRAILROAD MEDICARE
DCC074OtherGHMSI
MD093861102Medicaid
MD477099OtherAETNA HMO
MD5502048OtherAETNA PPO
MDKN35MIOtherCAREFIRST BCBS
MD477099OtherAETNA HMO
MD093861102Medicaid
MDG00224Medicare PIN