Provider Demographics
NPI:1154411445
Name:DOTSON, SAMUEL CHARLES III (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CHARLES
Last Name:DOTSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 C ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2136
Mailing Address - Country:US
Mailing Address - Phone:202-547-2309
Mailing Address - Fax:
Practice Address - Street 1:650 PENNSYLVANIA AVE SE
Practice Address - Street 2:SUITE 220
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4318
Practice Address - Country:US
Practice Address - Phone:202-543-2664
Practice Address - Fax:202-546-3244
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC17053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0269239000Medicaid
A71994Medicare UPIN
DC0269239000Medicaid