Provider Demographics
NPI:1417031030
Name:HODGE, CAROLINE T (PA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:T
Last Name:HODGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1803
Mailing Address - Country:US
Mailing Address - Phone:734-417-6177
Mailing Address - Fax:973-470-3506
Practice Address - Street 1:300 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2819
Practice Address - Country:US
Practice Address - Phone:973-470-3000
Practice Address - Fax:973-470-3506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00169200207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107224TLMMedicare PIN
P00449006Medicare PIN