Provider Demographics
NPI:1912007725
Name:HODGE, THEO WALLACE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THEO
Middle Name:WALLACE
Last Name:HODGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1140 VARNUM ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2153
Mailing Address - Country:US
Mailing Address - Phone:202-525-5175
Mailing Address - Fax:202-450-6088
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:405-220-2854
Practice Address - Fax:202-854-4832
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD18133207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG22464OtherUPIN