Healthcare Provider Details

I. General information

NPI: 1932215027
Provider Name (Legal Business Name): DAVID M. HODDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

1162 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-6426
  • Fax: 502-868-9724
Mailing address:
  • Phone: 502-863-6426
  • Fax: 502-868-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27933
License Number StateKY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1200219
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerUNITED HEALTH CARE
# 2
Identifier000000049848
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerANTHEM
# 3
Identifier4516896
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerAETNA
# 4
Identifier64279334
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: