Provider Demographics
NPI:1689922700
Name:BELL-DZIDE, DODZI (PA-C)
Entity Type:Individual
Prefix:
First Name:DODZI
Middle Name:
Last Name:BELL-DZIDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 MCDONOGH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5273
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:866-902-5997
Practice Address - Street 1:826 WASHINGTON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5750
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:443-605-3655
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD257053Y82Medicare PIN