Provider Demographics
NPI:1912420811
Name:DODSON, CAROL ANN (AGNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DODSON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1208 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21758-9125
Mailing Address - Country:US
Mailing Address - Phone:410-303-5594
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 130
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6240
Practice Address - Country:US
Practice Address - Phone:301-527-1650
Practice Address - Fax:301-527-8752
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164607363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology