Provider Demographics
NPI:1568469096
Name:HODA, TAHIRUL (MD)
Entity type:Individual
Prefix:MR
First Name:TAHIRUL
Middle Name:
Last Name:HODA
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 1:6889 ROUTE 434
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-3503
Mailing Address - Country:US
Mailing Address - Phone:607-625-4843
Mailing Address - Fax:607-625-4846
Practice Address - Street 1:6889 ROUTE 434
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-3503
Practice Address - Country:US
Practice Address - Phone:607-625-4843
Practice Address - Fax:607-625-4846
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189935207Q00000X
PAMD043985L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1249428Medicaid
NY01251514Medicaid
NYIA1210Medicare PIN
NY01251514Medicaid