Healthcare Provider Details

I. General information

NPI: 1093381337
Provider Name (Legal Business Name): KYLE HODGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

5801 BREMO RD
RICHMOND VA
23226-1907
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101289353
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: