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NPI Code Detail

MEDICARE: DR. GORDON R. HODAS M.D.

MEDICARE:  DR. GORDON R. HODAS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianMD016895-EPA

General Provider Information

NPI Number : 1437463783
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON R. HODAS M.D.
Provider Business Mailing Address
First Line : 214 E GRAVERS LN
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-2803
Country : US
Telephone Number : 215-247-1707
Fax Number :
Provider Business Practice Location Address
First Line : 8104 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-3423
Country : US
Telephone Number : 215-247-1707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2010
Last Update Date : 07/19/2016

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