Provider Demographics
NPI:1003136235
Name:HODSON, BENJAMIN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RICHARD
Last Name:HODSON
Suffix:
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:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:MEDICAL STAFF OFFICE T9
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-2754
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:MEDICAL STAFF OFFICE T9
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2754
Practice Address - Fax:631-444-6031
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY268743207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program