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NPI Code Detail

MEDICARE: DR. HEIDI ROSE HODDER DO

MEDICARE: DR. HEIDI ROSE HODDER DO
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
1207Q00000XFamily Medicine Physician250626-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC8362OTHERNYRR MEDICARE GROUP
2P00693903OTHERNYRR MEDICARE PIN
3AA0598OTHERNYMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942270970
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEIDI ROSE HODDER DO
Provider Business Mailing Address
First Line : 1 GUTHRIE SQ
Second Line :
City : SAYRE
State : PA
Zip : 18840-1625
Country : US
Telephone Number : 570-888-5858
Fax Number :
Provider Business Practice Location Address
First Line : 1336 CEDAR ST STE C
Second Line :
City : ELMIRA
State : NY
Zip : 14904-2951
Country : US
Telephone Number : 607-734-3929
Fax Number : 607-737-8054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 03/25/2021

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Directions to “ DR. HEIDI ROSE HODDER DO” Practice Location

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