Provider Demographics
NPI:1366591109
Name:WASHINGTON, DODE NOBIA (MD)
Entity type:Individual
Prefix:MRS
First Name:DODE
Middle Name:NOBIA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SINGLETON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9154
Mailing Address - Country:US
Mailing Address - Phone:843-349-0100
Mailing Address - Fax:843-349-0104
Practice Address - Street 1:620 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9154
Practice Address - Country:US
Practice Address - Phone:843-349-0100
Practice Address - Fax:843-349-0104
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2311207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT76307Medicaid
SCG488017876Medicare ID - Type Unspecified
SCT76307Medicaid