Provider Demographics
NPI:1801872916
Name:HODER, EDWARD L (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:HODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:9TH FLOOR - HARVARD VANGARD MEDICAL ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8239
Mailing Address - Fax:
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:HARVARD VANGARD MEDICAL ASSOCIATES
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2800
Practice Address - Fax:781-221-2680
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA60217208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0873965OtherCIGNA
MA12-04572OtherUNITED HEALTHCARE
MA722650OtherTUFTS
MAJ07891OtherBLUE CROSS
MA3547313OtherAETNA
MA0003778OtherNEIGHBORHOOD HEALTH
MAAA8202OtherHARVARD PILGRIM
MA3040020Medicaid
MAJ07891OtherBLUE CROSS
MA12-04572OtherUNITED HEALTHCARE