Provider Demographics
NPI:1619238466
Name:HODGE, GERALDINE MITCHELL
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:MITCHELL
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 BRIGHTSEAT RD
Mailing Address - Street 2:#302
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3526
Mailing Address - Country:US
Mailing Address - Phone:301-219-2176
Mailing Address - Fax:
Practice Address - Street 1:2242 BRIGHTSEAT RD
Practice Address - Street 2:#302
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-3526
Practice Address - Country:US
Practice Address - Phone:301-219-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide