Healthcare Provider Details

I. General information

NPI: 1568469096
Provider Name (Legal Business Name): TAHIRUL HODA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6889 ROUTE 434
APALACHIN NY
13732-3503
US

IV. Provider business mailing address

6889 ROUTE 434
APALACHIN NY
13732-3503
US

V. Phone/Fax

Practice location:
  • Phone: 607-625-4843
  • Fax: 607-625-4846
Mailing address:
  • Phone: 607-625-4843
  • Fax: 607-625-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number189935
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD043985L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: