Provider Demographics
NPI:1861444176
Name:DODD, JEFFREY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
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 1:2891 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7406
Mailing Address - Country:US
Mailing Address - Phone:804-897-1259
Mailing Address - Fax:804-897-6141
Practice Address - Street 1:2891 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7406
Practice Address - Country:US
Practice Address - Phone:804-897-1259
Practice Address - Fax:804-897-6141
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540883363OtherFIRST HEALTH/CCN
VA568498OtherAETNA
VA0100496OtherUNTIED HEALTHCARE
VA540883363OtherPHCS
VA540883363OtherVIRGINIA HEALTH NETWORK
VAC04469OtherGROUP PTAN
VA540883363OtherPREFERRED CARE
VA856735OtherMAMSI
VA10003380OtherOPTIMA
VA10522OtherCIGNA
VA5633966Medicaid
VA116037OtherANTHEM
VA540883363OtherCHAMPUS-TRICARE
VA540883363OtherGREAT WEST HEALTHCARE
VA82504OtherSOUTHERN HEALTH
VAC09633OtherGROUP PTAN
VA540883363OtherFIRST HEALTH/CCN
VA540883363OtherPHCS
VA540883363OtherPREFERRED CARE
VAF93939Medicare UPIN
VA10003380OtherOPTIMA
VAC09633OtherGROUP PTAN
VA080006603Medicare PIN