Basic Information
Provider Information
NPI: 1184910697
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DODWELL
FirstName: SARAH
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 SOUTHBOROUGH DR
Address2: SUITE 201
City: SOUTH PORTLAND
State: ME
PostalCode: 041066914
CountryCode: US
TelephoneNumber: 2076612000
FaxNumber:  
Practice Location
Address1: 49 SPRING ST
Address2:  
City: SCARBOROUGH
State: ME
PostalCode: 040748926
CountryCode: US
TelephoneNumber: 2078831414
FaxNumber: 2078831010
Other Information
ProviderEnumerationDate: 06/22/2011
LastUpdateDate: 07/26/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X248378MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
2084N0400XMD20965MEY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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