Provider Demographics
NPI:1356441513
Name:HODDER, SALLY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:LYNN
Last Name:HODDER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:30 BERGEN ST
Mailing Address - Street 2:ADMC 12 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 BERGEN ST
Practice Address - Street 2:ACC LEVEL D
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-4071
Practice Address - Fax:973-972-3102
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07557900207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ115036Medicare PIN