Provider Demographics
NPI:1801857933
Name:DODGE, MERRIEBETH (DO)
Entity Type:Individual
Prefix:
First Name:MERRIEBETH
Middle Name:
Last Name:DODGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1HOSPTAL ROAD
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-1477
Mailing Address - Country:US
Mailing Address - Phone:508-693-3164
Mailing Address - Fax:508-696-5238
Practice Address - Street 1:1 HOSPTAL ROAD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557-1477
Practice Address - Country:US
Practice Address - Phone:508-693-3164
Practice Address - Fax:508-696-5238
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220282207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10083969OtherCAPITAL PHYSICIANS HEALTH
MA469003OtherTUFTS
MAP00131174OtherRAILROAD MEDICARE
MAAA19492OtherHARVARD
MAJ27382OtherBCBS
MA2072220Medicaid
MA6298964OtherCIGNA INDEMNITY
MA000000028288OtherHEALTHNET
MA34098OtherHEALTH NEW ENGLAND
MA043531502OtherGIC INDEMNITY
MA781262OtherMVP
MA469003OtherTUFTS
MA2072220Medicaid
MAA36763Medicare PIN
MAA36763Medicare PIN