Provider Demographics
NPI:1427249846
Name:HODGE, STACI B (PA-C)
Entity type:Individual
Prefix:MS
First Name:STACI
Middle Name:B
Last Name:HODGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3333 NORTH CALVERT ST
Mailing Address - Street 2:GCOA
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-554-4382
Mailing Address - Fax:410-554-2084
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-554-4382
Practice Address - Fax:410-554-2084
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant