Provider Demographics
NPI:1174629661
Name:HODGE, JAMES BRIAN (MSPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:HODGE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 INSPIRATION LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5801
Mailing Address - Country:US
Mailing Address - Phone:301-990-7773
Mailing Address - Fax:
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1555
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-951-8593
Practice Address - Fax:301-951-8598
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1452-0011OtherCAREFIRST
DCP58238Medicare UPIN
DC017389M60Medicare ID - Type UnspecifiedMEDICARE