Provider Demographics
NPI:1780668848
Name:DODD, JARRETT S (MD)
Entity Type:Individual
Prefix:
First Name:JARRETT
Middle Name:S
Last Name:DODD
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 1:1175 CORPORATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2238
Mailing Address - Country:US
Mailing Address - Phone:434-525-6964
Mailing Address - Fax:434-525-4035
Practice Address - Street 1:1175 CORPORATE PARK DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2238
Practice Address - Country:US
Practice Address - Phone:434-525-6964
Practice Address - Fax:434-525-4035
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
061189OtherANTHEM
VA005613281Medicaid
080065406OtherMEDICARE RAILROAD
VAF67622Medicare UPIN
VA015107C58Medicare PIN