Healthcare Provider Details

I. General information

NPI: 1851576474
Provider Name (Legal Business Name): MARK ANTHONY HODGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 COURT ST
ABINGDON VA
24210-2921
US

IV. Provider business mailing address

351 COURT ST
ABINGDON VA
24210-2921
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-7127
  • Fax: 276-676-9366
Mailing address:
  • Phone: 276-676-7127
  • Fax: 276-676-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167636
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: