Provider Demographics
NPI:1487641163
Name:HODGES, CHARLES D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:HODGES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:429 N PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1815
Mailing Address - Country:US
Mailing Address - Phone:317-791-6691
Mailing Address - Fax:
Practice Address - Street 1:8244 E US HIGHWAY 36 STE 1100
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9627
Practice Address - Country:US
Practice Address - Phone:317-272-7500
Practice Address - Fax:317-272-7515
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2018-10-08
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Provider Licenses
StateLicense IDTaxonomies
IN01026260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100217690AMedicaid
IN100217690AMedicaid
IND69396Medicare UPIN