Basic Information
Provider Information
NPI: 1689891673
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HODGSON
FirstName: ERIC
MiddleName: JOHN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178224903
CountryCode: US
TelephoneNumber: 5702716144
FaxNumber: 5702716578
Practice Location
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178227506
CountryCode: US
TelephoneNumber: 5702716298
FaxNumber: 5702715841
Other Information
ProviderEnumerationDate: 04/19/2007
LastUpdateDate: 10/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VM0101X53048MTN Allopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
207VM0101X045287CTN Allopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
207VM0101XMD467267PAY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

No ID Information.


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