MEDICARE: DR. MARK P HODGKIN MD

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
1	207Q00000X	Family Medicine Physician	01032194A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528040102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK P HODGKIN MD

Provider Business Mailing Address
First Line	:	PO BOX 664056
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46266-4056
Country	:	US
Telephone Number	:	317-353-9777
Fax Number	:	317-357-6922

Provider Business Practice Location Address
First Line	:	5839 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219
Country	:	US
Telephone Number	:	317-353-9777
Fax Number	:	317-357-6922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	10/09/2013

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