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General NPI Number Information
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NPI Number | 1194019703
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Entity Type | Individual
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Provider Name | EILEEN TERESA HODGES PA
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 1540 MAPLE RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3647
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Country | US
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Telephone | 716-568-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 5905 CREEKVIEW DR
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City | CLARENCE CENTER
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State | NY
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Zip | 14032-9735
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Country | US
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Telephone | 716-480-1918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 014834
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License Number State | NY
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