Provider Demographics
NPI:1508055534
Name:DODAKIAN, MAUREEN C (NP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:C
Last Name:DODAKIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JOSEPH RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-7715
Mailing Address - Country:US
Mailing Address - Phone:508-523-0914
Mailing Address - Fax:
Practice Address - Street 1:9 JOSEPH RD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-7715
Practice Address - Country:US
Practice Address - Phone:508-523-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0393291Medicaid
MA0393291Medicaid