Provider Demographics
NPI:1598766685
Name:HODGE, CHARLES J JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:HODGE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:613 JACOBSEN HALL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-6505
Mailing Address - Fax:315-464-5520
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-4470
Practice Address - Fax:315-464-5520
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-06-17
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Provider Licenses
StateLicense IDTaxonomies
NY108474207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462226Medicaid
CC9330Medicare PIN
NY00462226Medicaid