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Organization
NICHOLAS DODGE, M.D., P.C.
Active
Organization
NICHOLAS DODGE, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS DODGE M.D. (PRESIDENT)
(570) 344-5115
Entity
Organization
Contact information
Practice address
414 E DRINKER ST STE 204, DUNMORE, PA 18512-2469
(570) 344-5115
(570) 344-2123
Mailing address
121 VOSBURG LN, CLARKS SUMMIT, PA 18411-2717
(570) 344-5115
(570) 344-2123
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD054271L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015086460006
—
PA
01
—
002981
FIRST PRIORITY HMO
PA
01
—
020395000
BLACK LUNG
PA
01
—
0763711000
BLUE CARE / BLUE SHIELD
PA
01
—
1669669859
NPI
PA
01
—
616633
FIRST PRIORITY LIFE
PA
01
—
DG7762
RAILROAD MEDICARE
PA
Enumeration date
10/01/2007
Last updated
12/06/2023
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