1720029366 NPI number — JONATHAN GARY HODOR DO

Table of content: JONATHAN GARY HODOR DO (NPI 1720029366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720029366 NPI number — JONATHAN GARY HODOR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODOR
Provider First Name:
JONATHAN
Provider Middle Name:
GARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720029366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15005 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-6340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-251-8611
Provider Business Mailing Address Fax Number:
301-251-8779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15005 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-251-8611
Provider Business Practice Location Address Fax Number:
301-251-8779
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  H86986 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3110875 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7400549 . This is a "AMERICHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 203003357 . This is a "GREAT WEST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 203003357 . This is a "PHCS (PPO/POS)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 116624 . This is a "PRIORITY PARTNERS ( JOHN HOPKINS HEALTH PLAN)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 264828 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 158013760 . This is a "MARYLAND PHYSICIANS CARE MCO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 884286 . This is a "BCBS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0002 . This is a "CAREFIRST BCBS DC GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1001337 . This is a "FIRST HEALTH/COVENTRY NATIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 203003357 . This is a "ADVENTIST HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 307954 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7485755 . This is a "AETNA NON HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1187636 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2154738 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4100589300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 754619 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".




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