Provider Demographics
NPI:1326279035
Name:HODGE, JODI V (PA-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:V
Last Name:HODGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:VON MAFFEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:196 PARKWAY S
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1234
Mailing Address - Country:US
Mailing Address - Phone:860-442-7027
Mailing Address - Fax:860-444-0074
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-443-4455
Practice Address - Fax:860-447-8961
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001462363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001462OtherSTATE LICENSE