Provider Demographics
NPI:1255370029
Name:HODGE, ROGER A (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:HODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:104 WOODMONT BLVD
Mailing Address - Street 2:SUITE LL50
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-386-2300
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-297-2700
Practice Address - Fax:615-269-4584
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN17145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01047197OtherAMERIGROUP TENNCARE
TN12078788OtherMULTIPLAN/PHCS
TN11006437OtherGEHA
TN1508026Medicaid
TN4116585OtherAETNA
TN258562OtherUSA MANAGED CARE
TN4038071OtherBLUE CROSS OF TN
TN813016OtherUNITED HEALTH CARE
TNQ006397Medicaid
KY64911563Medicaid
TN1550164OtherCIGNA PPO/POS
TN1058211OtherCOVENTRY/FIRST HEALTH
TN110237380OtherMEDICARE RR
TN110237380OtherMEDICARE RR
TNQ006397Medicaid