Provider Demographics
NPI:1821017914
Name:HODGSON, ELIZABETH SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:HODGSON
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 1:201 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:973-926-4638
Mailing Address - Fax:973-923-6487
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-4638
Practice Address - Fax:973-923-6487
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06103600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ727642B3LOtherMEDICARE ID
NJ7412606Medicaid
NJ727642B3LOtherMEDICARE ID