Provider Demographics
NPI:1811942113
Name:DODGE, PATRICIA L (CNM)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:DODGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 GREENBUSH DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2911
Mailing Address - Country:US
Mailing Address - Phone:614-866-0622
Mailing Address - Fax:
Practice Address - Street 1:920 N. HAMILTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-366-3075
Practice Address - Fax:614-366-0894
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN183386 NM04011367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2046619Medicaid
OH2046619Medicaid
OH03141Medicare PIN