Provider Demographics
NPI:1710974209
Name:HODGES, MARK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WASHINGTON SQ STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1751
Mailing Address - Country:US
Mailing Address - Phone:740-333-6463
Mailing Address - Fax:740-333-1726
Practice Address - Street 1:310 WASHINGTON SQ STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1751
Practice Address - Country:US
Practice Address - Phone:740-333-6463
Practice Address - Fax:740-333-1726
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2137940Medicaid
OH4051751Medicare PIN
H05824Medicare ID - Type Unspecified
OH2137940Medicaid