Healthcare Provider Details

I. General information

NPI: 1801872916
Provider Name (Legal Business Name): EDWARD L HODER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WALL ST HARVARD VANGARD MEDICAL ASSOCIATES
BURLINGTON MA
01803-4758
US

IV. Provider business mailing address

147 MILK ST 9TH FLOOR - HARVARD VANGARD MEDICAL ASSOCIATES
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 781-221-2800
  • Fax: 781-221-2680
Mailing address:
  • Phone: 617-559-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60217
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number60217
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: