Provider Demographics
NPI:1154640480
Name:NICOLE C HODGE MD PA
Entity Type:Organization
Organization Name:NICOLE C HODGE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIVARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-550-5300
Mailing Address - Street 1:1115 PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3354
Mailing Address - Country:US
Mailing Address - Phone:214-550-5399
Mailing Address - Fax:
Practice Address - Street 1:1115 PHILIP DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3354
Practice Address - Country:US
Practice Address - Phone:214-550-5399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7272207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty