Basic Information
| Provider Information | |||||||||
| NPI: | 1811949027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 N ORANGE AVE STE 182 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328044675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073035857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 E ROLLINS ST | ||||||||
| Address2: | RADIATION ONCOLOGY | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073035857 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0203X | 1360 | WI | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0001X | ME103158 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.