Individual
RIANE DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
214 KING ST, OGDENSBURG, NY 13669-1142
(315) 393-3600
Mailing address
214 KING ST, OGDENSBURG, NY 13669-1142
(315) 393-3600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2136
SC
363AM0700X
Medical Physician Assistant
Primary
018141
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04262240
—
NY
Enumeration date
08/29/2014
Last updated
06/25/2019
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