Provider Demographics
NPI:1871532549
Name:DODSWORTH, KATHLEEN M (DPM)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:DODSWORTH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-264-0110
Mailing Address - Fax:585-264-9469
Practice Address - Street 1:61 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-264-0110
Practice Address - Fax:585-264-9469
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0045471213E00000X
FLP02331213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD469MOtherPREFERRED CARE
NY480011961OtherRAILROAD MEDICARE
P010004547OtherEXCELLUS
P010004547OtherEXCELLUS
MD469MOtherPREFERRED CARE
NY10336BMedicare PIN