Provider Demographics
NPI:1063609402
Name:HODGE, ANDREW L (PA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:HODGE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:193 STONER AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5587
Mailing Address - Country:US
Mailing Address - Phone:410-751-5606
Mailing Address - Fax:410-751-5603
Practice Address - Street 1:193 STONER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5587
Practice Address - Country:US
Practice Address - Phone:410-751-5606
Practice Address - Fax:410-751-5603
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2015-08-04
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Provider Licenses
StateLicense IDTaxonomies
MDC0003695363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD361754YBDBMedicare PIN