Provider Demographics
NPI:1205963063
Name:TAHIRUL HODA
Entity type:Organization
Organization Name:TAHIRUL HODA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAHIRUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-765-4912
Mailing Address - Street 1:6889 ROUTE 434
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-3503
Mailing Address - Country:US
Mailing Address - Phone:607-625-4843
Mailing Address - Fax:607-625-4846
Practice Address - Street 1:6889 ROUTE 434
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-3503
Practice Address - Country:US
Practice Address - Phone:607-625-4843
Practice Address - Fax:607-625-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01251514Medicaid
IA1210Medicare PIN
E86290Medicare UPIN