Healthcare Provider Details

I. General information

NPI: 1861955155
Provider Name (Legal Business Name): JORDESHA M HODGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date: 11/27/2019
Reactivation Date: 12/09/2019

III. Provider practice location address

3300 MAIN STREET 3RD FL, SUITE A
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7031
  • Fax: 413-794-7133
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1018827
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: