Provider Demographics
NPI:1881734168
Name:HODGES, DAVID MARK (MD,)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:HODGES
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 1:615 STANDISH RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1817
Mailing Address - Country:US
Mailing Address - Phone:201-816-9266
Mailing Address - Fax:201-816-9242
Practice Address - Street 1:12 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2803
Practice Address - Country:US
Practice Address - Phone:201-816-9266
Practice Address - Fax:201-816-9242
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06210000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ688339Medicare PIN
NJ067711Medicare PIN
NJB98078Medicare UPIN