Provider Demographics
NPI:1396916730
Name:HODGKISS, JOSEPH EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:HODGKISS
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:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-373-0212
Mailing Address - Fax:704-373-1216
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:SUITE 300- ADULT CARDIOLOGY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5863
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:704-373-1216
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061867A207R00000X
NC2011-00458207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396916730Medicaid
NC5919147Medicaid
SCNC1499Medicaid
NCNC3215AMedicare PIN