Provider Demographics
NPI:1295173235
Name:HODGE, DANIEL KENNETH JR (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KENNETH
Last Name:HODGE
Suffix:JR
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 1:1800 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5909
Mailing Address - Country:US
Mailing Address - Phone:177-695-6104
Mailing Address - Fax:
Practice Address - Street 1:1800 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5909
Practice Address - Country:US
Practice Address - Phone:177-695-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256801207R00000X
PAMD467395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty