Basic Information
| Provider Information | |||||||||
| NPI: | 1942216049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGSON | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1070 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027221070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763292 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 289 PLEASANT ST | ||||||||
| Address2: | STE 401 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027213005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763292 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 2218 | MA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 0703401 | 05 | MA | MEDICAID | 7997286 | 01 | MA | CIGNA | OTHER | AA23770 | 01 | MA | HARVARD PILGRIM HEALTH | OTHER | 000000029116 | 01 | MA | HEALTHNET PLAN | OTHER | 29369-7 | 01 | RI | RHODE ISLAND BS | OTHER | 412437 | 01 | RI | RHODE ISLAND BLUE CHIP | OTHER | Y71121 | 01 | MA | BLUE SHIELD OF MA | OTHER | 462334 | 01 | MA | TUFTS HEALTH PLAN | OTHER |