Provider Demographics
NPI:1083647267
Name:HODGES, JOANNE KIMBERLEE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:KIMBERLEE
Last Name:HODGES
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:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4597
Mailing Address - Country:US
Mailing Address - Phone:301-533-4000
Mailing Address - Fax:301-533-4208
Practice Address - Street 1:251 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-533-4000
Practice Address - Fax:301-533-4208
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2018-09-27
Deactivation Date:2006-07-19
Deactivation Code:
Reactivation Date:2006-09-07
Provider Licenses
StateLicense IDTaxonomies
MDD85274207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1083647267Medicaid
MD472003200Medicaid
NY01899852Medicaid