Healthcare Provider Details

I. General information

NPI: 1235135773
Provider Name (Legal Business Name): JULIE A HODGES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A MARINO PA-C

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST FL 2
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST FL 2
ERIE PA
16507-1537
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-8980
  • Fax: 814-451-0443
Mailing address:
  • Phone: 814-456-8980
  • Fax: 814-451-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002303L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: