Provider Demographics
NPI:1215989173
Name:HODGE, ROBERT WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:HODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3835
Mailing Address - Country:US
Mailing Address - Phone:716-434-6141
Mailing Address - Fax:716-434-0594
Practice Address - Street 1:160 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3835
Practice Address - Country:US
Practice Address - Phone:716-434-6141
Practice Address - Fax:716-434-0594
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY184736-7208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01449485Medicaid
NYF51566Medicare UPIN
NYBB6500Medicare ID - Type Unspecified