Provider Demographics
NPI:1508968579
Name:HODGDON, GRETCHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:A
Last Name:HODGDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3937
Mailing Address - Fax:607-547-6915
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3937
Practice Address - Fax:607-547-6915
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621470Medicaid
NY02917733Medicaid
NYH97529Medicare UPIN
OH2621470Medicaid
OH4166051Medicare ID - Type Unspecified