Healthcare Provider Details

I. General information

NPI: 1033214911
Provider Name (Legal Business Name): WALTER J HODGES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 JOSEPH SIEWICK DR 400
FAIRFAX VA
22033-1756
US

IV. Provider business mailing address

3620 JOSEPH SIEWICK DR 400
FAIRFAX VA
22033-1756
US

V. Phone/Fax

Practice location:
  • Phone: 703-264-7801
  • Fax: 703-264-7807
Mailing address:
  • Phone: 703-264-7801
  • Fax: 703-264-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101019262
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: