Provider Demographics
NPI:1982644019
Name:DODDS, GEORGE M I (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:DODDS
Suffix:I
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 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-261-6034
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:77 W. BARNEY ST.
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642
Practice Address - Country:US
Practice Address - Phone:315-287-4440
Practice Address - Fax:315-287-1858
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243767208M00000X, 2080A0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01270039Medicaid
NY01995615Medicaid
NY01270039Medicaid
F39756Medicare UPIN