Provider Demographics
NPI:1720029366
Name:HODOR, JONATHAN GARY (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GARY
Last Name:HODOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15005 SHADY GROVE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6340
Mailing Address - Country:US
Mailing Address - Phone:301-251-8611
Mailing Address - Fax:301-251-8779
Practice Address - Street 1:15005 SHADY GROVE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6340
Practice Address - Country:US
Practice Address - Phone:301-251-8611
Practice Address - Fax:301-251-8779
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH86986207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3110875OtherCIGNA
MD7400549OtherAMERICHOICE
MD203003357OtherGREAT WEST
MD203003357OtherPHCS (PPO/POS)
MD116624OtherPRIORITY PARTNERS ( JOHN HOPKINS HEALTH PLAN)
MD264828OtherKAISER
MD158013760OtherMARYLAND PHYSICIANS CARE MCO
MD884286OtherBCBS OF MARYLAND
MD0002OtherCAREFIRST BCBS DC GROUP
MD1001337OtherFIRST HEALTH/COVENTRY NATIONAL
MD203003357OtherADVENTIST HEALTHCARE
MD307954OtherAMERIGROUP
MD7485755OtherAETNA NON HMO
MD1187636OtherAETNA HMO
MD2154738OtherUNITED HEALTHCARE
MD4100589300Medicaid
754619OtherNCPPO
MD1001337OtherFIRST HEALTH/COVENTRY NATIONAL
754619OtherNCPPO