1720029366 NPI number — JONATHAN GARY HODOR DO

Table of content: (NPI 1437993383)

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:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 NEVIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20817-4740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-524-8623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 NEVIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-524-8623
Provider Business Practice Location Address Fax Number:
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: 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: 2154738 . This is a "UNITED HEALTHCARE" 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: 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: 203003357 . This is a "ADVENTIST HEALTHCARE" 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: 7400549 . This is a "AMERICHOICE" 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: 4100589300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 307954 . This is a "AMERIGROUP" 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: 3110875 . This is a "CIGNA" 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: 754619 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".




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