Provider Demographics
NPI:1962493536
Name:HODGES, MICHAEL BYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BYRON
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 1:272 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1618
Mailing Address - Country:US
Mailing Address - Phone:617-796-7170
Mailing Address - Fax:617-796-7171
Practice Address - Street 1:272 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1618
Practice Address - Country:US
Practice Address - Phone:617-796-7170
Practice Address - Fax:617-796-7171
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3119360Medicaid
MA078659OtherTUFTS HEALTH PLAN
MAJ14262OtherBCBS MA
MA078659OtherTUFTS HEALTH PLAN
F69121Medicare UPIN