Provider Demographics
NPI:1720103534
Name:HODGDON, WILFRED P (MD)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:P
Last Name:HODGDON
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 1:233 WAVERLEY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7353
Mailing Address - Country:US
Mailing Address - Phone:617-381-7150
Mailing Address - Fax:
Practice Address - Street 1:EMER DEPT WIDDEN HOSP
Practice Address - Street 2:103 GARLAND STREET
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:617-381-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42608207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine