Provider Demographics
NPI:1417949868
Name:HODGES, KATHRYN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:HODGES
Suffix:
Gender:F
Credentials:DC
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 428
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619
Mailing Address - Country:US
Mailing Address - Phone:410-266-3888
Mailing Address - Fax:410-266-3880
Practice Address - Street 1:43 OLD SOLOMONS ISLAND ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-3888
Practice Address - Fax:410-266-3880
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-20
Last Update Date:2020-07-20
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-05-22
Provider Licenses
StateLicense IDTaxonomies
MDS01447111NS0005X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM339KAOtherCAREFIRST BCBS MD PROV ID
DC2089OtherBCBS-DC PROVIDER ID
MD521800109OtherTAX ID#
MD239091OtherUHC,MAMSI,MDIPA,OPTCH ID
MDM339Medicare ID - Type Unspecified
DC2089OtherBCBS-DC PROVIDER ID