Healthcare Provider Details

I. General information

NPI: 1720029366
Provider Name (Legal Business Name): JONATHAN GARY HODOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 NEVIS RD
BETHESDA MD
20817-4740
US

IV. Provider business mailing address

7400 NEVIS RD
BETHESDA MD
20817-4740
US

V. Phone/Fax

Practice location:
  • Phone: 301-524-8623
  • Fax:
Mailing address:
  • Phone: 301-524-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberH86986
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A24341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: