Healthcare Provider Details

I. General information

NPI: 1881140630
Provider Name (Legal Business Name): HERBERT HODGDON II BS-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDUSTRIAL PARK DR SUITE 12
CONCORD NH
03301-8520
US

IV. Provider business mailing address

2 INDUSTRIAL PARK DRIVE SUITE 12
CONCORD NH
03301-8520
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9043
  • Fax: 603-228-2133
Mailing address:
  • Phone: 603-224-9043
  • Fax: 603-228-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: